Provider Demographics
NPI:1801100961
Name:THERAPY HUT
Entity type:Organization
Organization Name:THERAPY HUT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DWAYNE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:520-678-1115
Mailing Address - Street 1:2876 SOLARRO DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-6922
Mailing Address - Country:US
Mailing Address - Phone:520-678-1115
Mailing Address - Fax:
Practice Address - Street 1:2876 SOLARRO DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-6922
Practice Address - Country:US
Practice Address - Phone:520-678-1115
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-31
Last Update Date:2010-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ454007103K00000X
AZLMFT 10273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA43535OtherCALIFORNIA MARRIAGE AND FAMIYL THERAPIST
AZLMFT10273OtherARIZONA MARRIAGE AND FAMILY THERAPIST