Provider Demographics
NPI:1801950381
Name:KRUSE, BERNARD L (EDS, NCSP)
Entity type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:L
Last Name:KRUSE
Suffix:
Gender:M
Credentials:EDS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32919 W CENTER ST
Mailing Address - Street 2:
Mailing Address - City:WITTMANN
Mailing Address - State:AZ
Mailing Address - Zip Code:85361-9433
Mailing Address - Country:US
Mailing Address - Phone:623-388-2321
Mailing Address - Fax:623-388-2915
Practice Address - Street 1:32919 W CENTER ST
Practice Address - Street 2:
Practice Address - City:WITTMANN
Practice Address - State:AZ
Practice Address - Zip Code:85361-9433
Practice Address - Country:US
Practice Address - Phone:623-388-2321
Practice Address - Fax:623-388-2915
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool