Provider Demographics
NPI:1942384524
Name:KRUSEN, RICHARD MONTGOMERY (PHD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:MONTGOMERY
Last Name:KRUSEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 392
Mailing Address - Street 2:
Mailing Address - City:HUFFMAN
Mailing Address - State:TX
Mailing Address - Zip Code:77336-0392
Mailing Address - Country:US
Mailing Address - Phone:281-686-8562
Mailing Address - Fax:
Practice Address - Street 1:3010 SCOTT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6800
Practice Address - Country:US
Practice Address - Phone:254-773-4022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2007-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23855103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612787Medicare PIN