Provider Demographics
NPI:1831524370
Name:STUART KRAUSE PHD CLINICAL PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:STUART KRAUSE PHD CLINICAL PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JIM
Authorized Official - Middle Name:S
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:605-791-0666
Mailing Address - Street 1:643 NORTHERN LIGHTS BLVD
Mailing Address - Street 2:APT 1311
Mailing Address - City:BOX ELDER
Mailing Address - State:SD
Mailing Address - Zip Code:57719-6109
Mailing Address - Country:US
Mailing Address - Phone:605-791-0666
Mailing Address - Fax:
Practice Address - Street 1:550 N 5TH ST
Practice Address - Street 2:STE 3210
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-1375
Practice Address - Country:US
Practice Address - Phone:605-791-0666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD511103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty