Healthcare Provider Details

I. General information

NPI: 1356525224
Provider Name (Legal Business Name): KREUZ CLINICAL SERVICES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 OAKSTONE DR SUITE B
COLUMBUS OH
43231-7612
US

IV. Provider business mailing address

2525 OAKSTONE DR SUITE B
COLUMBUS OH
43231-7612
US

V. Phone/Fax

Practice location:
  • Phone: 614-325-6752
  • Fax: 614-436-5138
Mailing address:
  • Phone: 614-325-6752
  • Fax: 614-436-5138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI4716
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberF117
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number841152
License Number StateOH

VIII. Authorized Official

Name: MR. JOHN ROBERT KREUZ
Title or Position: PRESIDENT
Credential: LISW, LICDC, LIMFT
Phone: 614-325-6752