Provider Demographics
NPI:1407418270
Name:KRUGER, MARK AUSTIN (BCBA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:AUSTIN
Last Name:KRUGER
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3051 KIRKLEVINGTON DR APT 47
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40517-2435
Mailing Address - Country:US
Mailing Address - Phone:978-895-7864
Mailing Address - Fax:
Practice Address - Street 1:3051 KIRKLEVINGTON DR APT 47
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40517-2435
Practice Address - Country:US
Practice Address - Phone:978-895-7864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-02
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst