Provider Demographics
NPI:1912048620
Name:KRAUSE, COREY H (BA, LBSW)
Entity Type:Individual
Prefix:MR
First Name:COREY
Middle Name:H
Last Name:KRAUSE
Suffix:
Gender:M
Credentials:BA, LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4958 DICKSON DR
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48310-4631
Mailing Address - Country:US
Mailing Address - Phone:586-795-9731
Mailing Address - Fax:
Practice Address - Street 1:3701 E 13 MILE RD STE B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48092-3795
Practice Address - Country:US
Practice Address - Phone:586-274-0200
Practice Address - Fax:586-274-0228
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802013032104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker