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General NPI Number Information
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NPI Number | 1285232397
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Entity Type | Organization
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Legal Business Name | DR TONY J KREUCH LLC
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Dates
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Enumeration Date | 10/12/2020
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 2204 BROTHERS RD STE B
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City | SANTA FE
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State | NM
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Zip | 87505-6975
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Country | US
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Telephone | 505-269-9015
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Fax |
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Provider Business Mailing Address
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Address Line | 3201 ZAFARANO DR STE C
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City | SANTA FE
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State | NM
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Zip | 87507-2672
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Country | US
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Telephone | 505-269-9015
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | TONY KREUCH
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Credential | PSYD
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Telephone | 505-269-9015
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TP0016X
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Taxonomy Name | Prescribing (Medical) Psychologist
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License Number |
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License Number State |
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