Healthcare Provider Details

I. General information

NPI: 1235306440
Provider Name (Legal Business Name): LINDA KRAUSSE PH.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 W SHAW AVE STE 101
FRESNO CA
93711-3307
US

IV. Provider business mailing address

2501 W SHAW AVE STE 101
FRESNO CA
93711-3307
US

V. Phone/Fax

Practice location:
  • Phone: 559-221-1680
  • Fax: 559-221-4336
Mailing address:
  • Phone: 559-221-1680
  • Fax: 559-221-4336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberH10807
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: