Healthcare Provider Details

I. General information

NPI: 1891768701
Provider Name (Legal Business Name): STEVEN KRAUSHAAR PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 10/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKINGS DR
SAINT LOUIS MO
63130-4862
US

IV. Provider business mailing address

1201 BROOKINGS DR C B 1201
SAINT LOUIS MO
63130
US

V. Phone/Fax

Practice location:
  • Phone: 314-935-6666
  • Fax: 314-935-8515
Mailing address:
  • Phone: 314-935-6666
  • Fax: 314-935-5781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2007015268
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: