Healthcare Provider Details

I. General information

NPI: 1780934661
Provider Name (Legal Business Name): KRUSE CONSULTING INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2012
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

645 W LUMSDEN RD
BRANDON FL
33511-5911
US

IV. Provider business mailing address

645 W LUMSDEN RD
BRANDON FL
33511-5911
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-9322
  • Fax: 813-643-1457
Mailing address:
  • Phone: 813-654-9322
  • Fax: 813-643-1457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY 5932
License Number StateFL

VIII. Authorized Official

Name: STEVEN JOHN KRUSE
Title or Position: PRESIDENT
Credential: PHD
Phone: 813-654-9322