Provider Demographics
NPI:1104176064
Name:BROOKE KRAUSHAAR,PSY.D,LLC
Entity type:Organization
Organization Name:BROOKE KRAUSHAAR,PSY.D,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KRAUSHAAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:314-210-2001
Mailing Address - Street 1:9890 CLAYTON RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1685
Mailing Address - Country:US
Mailing Address - Phone:314-210-2001
Mailing Address - Fax:
Practice Address - Street 1:6321 ALAMO AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63105-3103
Practice Address - Country:US
Practice Address - Phone:314-210-2001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-18
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2007003961103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1477685477OtherNPI