Provider Demographics
NPI:1790137917
Name:KRUSE, JENNA (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:KRUSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3910 S OLD HIGHWAY 94 STE 103
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2834
Mailing Address - Country:US
Mailing Address - Phone:636-283-0088
Mailing Address - Fax:636-284-2456
Practice Address - Street 1:3910 S OLD HIGHWAY 94 STE 103
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63304-2834
Practice Address - Country:US
Practice Address - Phone:636-283-0088
Practice Address - Fax:636-284-2456
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015019584106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist