Provider Demographics
NPI:1457653867
Name:KRUSE, CAROL KAY (LCPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:KAY
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 MIDWEST RD
Mailing Address - Street 2:STE 213
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-8204
Mailing Address - Country:US
Mailing Address - Phone:630-828-8120
Mailing Address - Fax:630-828-8122
Practice Address - Street 1:2210 MIDWEST RD
Practice Address - Street 2:STE 213
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-8204
Practice Address - Country:US
Practice Address - Phone:630-828-8120
Practice Address - Fax:630-828-8122
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL5456520101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional