Healthcare Provider Details

I. General information

NPI: 1649229899
Provider Name (Legal Business Name): ANDREA ELLEN KRUEGER M.ED., MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2649 W HORIZON RIDGE PKWY SUITE 130
HENDERSON NV
89052-4801
US

IV. Provider business mailing address

2649 W HORIZON RIDGE PKWY SUITE 130
HENDERSON NV
89052-4801
US

V. Phone/Fax

Practice location:
  • Phone: 702-696-9490
  • Fax: 702-796-9490
Mailing address:
  • Phone: 702-696-9490
  • Fax: 702-796-9490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0439
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: