Healthcare Provider Details

I. General information

NPI: 1568159507
Provider Name (Legal Business Name): JOHN CARL KRAUSE III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9740 CONANT ST STE 5
HAMTRAMCK MI
48212-3307
US

IV. Provider business mailing address

2891 E MAPLE RD STE 200
TROY MI
48083-6106
US

V. Phone/Fax

Practice location:
  • Phone: 586-405-5980
  • Fax: 248-914-3211
Mailing address:
  • Phone: 248-726-0127
  • Fax: 248-914-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6851122258
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: