Individual
KLINTON R. KROUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
HSPP
Contact information
Practice address
2100 GOSHEN RD, FORT WAYNE, IN 46808-1493
(260) 471-3500
(260) 471-4263
Mailing address
PO BOX 497, 2621 E. JEFFERSON ST., WARSAW, IN 46581-0497
(574) 267-7169
(574) 269-5573
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
39001609A
IN
103TC0700X
Clinical Psychologist
Primary
20042736A
IN
Other
Enumeration date
11/16/2009
Last updated
02/14/2014
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