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General NPI Number Information
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NPI Number | 1801100961
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Entity Type | Organization
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Legal Business Name | THERAPY HUT
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Dates
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Enumeration Date | 07/31/2010
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Last Update Date | 07/31/2010
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Provider Practice Location Address
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Address Line | 2876 SOLARRO DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6922
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Country | US
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Telephone | 520-678-1115
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Fax |
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Provider Business Mailing Address
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Address Line | 2876 SOLARRO DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-6922
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Country | US
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Telephone | 520-678-1115
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | MR. DWAYNE ALLEN KRUSE
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Credential | MA LMFT
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Telephone | 520-678-1115
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 454007
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 10273
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License Number State | AZ
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