Provider Demographics
NPI:1285232397
Name:DR TONY J KREUCH LLC
Entity Type:Organization
Organization Name:DR TONY J KREUCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:KREUCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:505-269-9015
Mailing Address - Street 1:3201 ZAFARANO DR STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-2672
Mailing Address - Country:US
Mailing Address - Phone:505-269-9015
Mailing Address - Fax:
Practice Address - Street 1:2204 BROTHERS RD STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6975
Practice Address - Country:US
Practice Address - Phone:505-269-9015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-12
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Single Specialty