Provider Demographics
NPI:1740478312
Name:KRAUTHEIM, MARK D (PHD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:KRAUTHEIM
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 1:750 CRICKET LN
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3105
Mailing Address - Country:US
Mailing Address - Phone:419-874-0878
Mailing Address - Fax:
Practice Address - Street 1:750 CRICKET LN
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3105
Practice Address - Country:US
Practice Address - Phone:419-874-0878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5649103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling