Provider Demographics
NPI:1619009107
Name:DANIEL E. KRUGER, LLC
Entity Type:Organization
Organization Name:DANIEL E. KRUGER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRUGER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:520-981-2511
Mailing Address - Street 1:5635 E HOLMES ST
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2447
Mailing Address - Country:US
Mailing Address - Phone:520-981-2511
Mailing Address - Fax:520-514-5233
Practice Address - Street 1:6612 E CARONDELET DR
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85710-2119
Practice Address - Country:US
Practice Address - Phone:520-981-2511
Practice Address - Fax:520-514-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3667103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ886020Medicaid
AZ886020Medicaid