Provider Demographics
NPI:1477025039
Name:JUSTER KRUSE, MARIO (MHC - LP)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:JUSTER KRUSE
Suffix:
Gender:M
Credentials:MHC - LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 S STERLING AVE STE 216
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4542
Mailing Address - Country:US
Mailing Address - Phone:727-417-0848
Mailing Address - Fax:
Practice Address - Street 1:730 S STERLING AVE STE 216
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4542
Practice Address - Country:US
Practice Address - Phone:813-812-4940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH19817101YM0800X
NYP14374101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health