Provider Demographics
NPI:1598431629
Name:LAURA KRAUSE, LCSW-C LLC
Entity Type:Organization
Organization Name:LAURA KRAUSE, LCSW-C LLC
Other - Org Name:TELEHEALTH TRAUMA THERAPY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER /PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-422-7188
Mailing Address - Street 1:MSC 267 PO BOX 673027
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77267-3027
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8736 POLISHED PEBBLE WAY
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-5909
Practice Address - Country:US
Practice Address - Phone:607-425-7743
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-18
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1528389798Medicaid