Provider Demographics
NPI:1548072556
Name:TEMPLETON-CARDAMONI, CRYMSON ALEXIS (BA)
Entity type:Individual
Prefix:
First Name:CRYMSON
Middle Name:ALEXIS
Last Name:TEMPLETON-CARDAMONI
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1783 LORETTA CIR
Mailing Address - Street 2:
Mailing Address - City:ESSEXVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48732-9408
Mailing Address - Country:US
Mailing Address - Phone:989-501-2061
Mailing Address - Fax:
Practice Address - Street 1:1908 W YOUNGS DITCH RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-6969
Practice Address - Country:US
Practice Address - Phone:989-893-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-25
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician