Provider Demographics
NPI:1720840036
Name:KRAUSE MARRIAGE & FAMILY THERAPY CORP
Entity Type:Organization
Organization Name:KRAUSE MARRIAGE & FAMILY THERAPY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-442-0037
Mailing Address - Street 1:PO BOX 7454
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91510-7454
Mailing Address - Country:US
Mailing Address - Phone:424-442-0037
Mailing Address - Fax:
Practice Address - Street 1:1911 N BUENA VISTA ST UNIT 423
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91504-3396
Practice Address - Country:US
Practice Address - Phone:424-442-0037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-23
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699376368OtherNPI 1