MEDICARE: BROOKE KRAUSHAAR,PSY.D,LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	2007003961	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1477685477	OTHER	MO	NPI

General Provider Information

NPI Number	:	1104176064
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BROOKE KRAUSHAAR,PSY.D,LLC

Provider Business Mailing Address
First Line	:	9890 CLAYTON RD
Second Line	:	SUITE 100
City	:	SAINT LOUIS
State	:	MO
Zip	:	63124-1685
Country	:	US
Telephone Number	:	314-210-2001
Fax Number	:

Provider Business Practice Location Address
First Line	:	6321 ALAMO AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63105-3103
Country	:	US
Telephone Number	:	314-210-2001
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BROOKE E KRAUSHAAR
Credential	:	PSY.D.
Telephone Number	:	314-210-2001

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	09/18/2012

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