Healthcare Provider Details

I. General information

NPI: 1205106028
Provider Name (Legal Business Name): MARIA ADELA KRAUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2012
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 MCLEOD DR
LAS VEGAS NV
89121-5215
US

IV. Provider business mailing address

5854 CRUMBLING RIDGE ST
HENDERSON NV
89011-1640
US

V. Phone/Fax

Practice location:
  • Phone: 702-474-6450
  • Fax: 702-474-6463
Mailing address:
  • Phone: 702-574-7475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00651-C
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number06897-IG
License Number StateNV
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberCI3069
License Number StateNV
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberCP5740
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: