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General NPI Number Information
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NPI Number | 1104176064
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Entity Type | Organization
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Legal Business Name | BROOKE KRAUSHAAR,PSY.D,LLC
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 6321 ALAMO AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63105-3103
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Country | US
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Telephone | 314-210-2001
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Fax |
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Provider Business Mailing Address
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Address Line | 9890 CLAYTON RD SUITE 100
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1685
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Country | US
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Telephone | 314-210-2001
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BROOKE E KRAUSHAAR
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Credential | PSY.D.
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Telephone | 314-210-2001
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2007003961
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License Number State | MO
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