Healthcare Provider Details

I. General information

NPI: 1023940731
Provider Name (Legal Business Name): LAURIN NICOLE VON KRUEGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4880 W UNIVERSITY AVE STE B2
LAS VEGAS NV
89103-3830
US

IV. Provider business mailing address

2760 TYNDRUM AVE
HENDERSON NV
89044-8769
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-5943
  • Fax: 725-251-2409
Mailing address:
  • Phone: 702-378-9587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberCI5727
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: