Healthcare Provider Details

I. General information

NPI: 1801100961
Provider Name (Legal Business Name): THERAPY HUT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2010
Last Update Date: 07/31/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2876 SOLARRO DR
SIERRA VISTA AZ
85635-6922
US

IV. Provider business mailing address

2876 SOLARRO DR
SIERRA VISTA AZ
85635-6922
US

V. Phone/Fax

Practice location:
  • Phone: 520-678-1115
  • Fax:
Mailing address:
  • Phone: 520-678-1115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number454007
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 10273
License Number StateAZ

VIII. Authorized Official

Name: MR. DWAYNE ALLEN KRUSE
Title or Position: OWNER/DIRECTOR
Credential: MA LMFT
Phone: 520-678-1115