MEDICARE: PAULA KRASSELT LPC-10694

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	LPC-10694	AZ

General Provider Information

NPI Number	:	1588111405
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAULA KRASSELT LPC-10694

Provider Business Mailing Address
First Line	:	900 E FLORENCE BLVD STE G
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-4673
Country	:	US
Telephone Number	:	520-836-4278
Fax Number	:	520-836-1786

Provider Business Practice Location Address
First Line	:	900 E FLORENCE BLVD STE G
Second Line	:
City	:	CASA GRANDE
State	:	AZ
Zip	:	85122-4673
Country	:	US
Telephone Number	:	520-836-4278
Fax Number	:	520-836-1786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2016
Last Update Date	:	09/08/2016

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