Provider Demographics
NPI:1205106028
Name:KRAUSE, MARIA ADELA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:ADELA
Last Name:KRAUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5854 CRUMBLING RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89011-1640
Mailing Address - Country:US
Mailing Address - Phone:702-574-7475
Mailing Address - Fax:
Practice Address - Street 1:4221 MCLEOD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89121-5215
Practice Address - Country:US
Practice Address - Phone:702-474-6450
Practice Address - Fax:702-474-6463
Is Sole Proprietor?:No
Enumeration Date:2012-01-10
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV00651-C101YA0400X
NV06897-IG103TA0400X
NVCI3069103TC2200X
NVCP5740101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent