Individual
MARY JANE KRUSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, CAC III
Contact information
Practice address
328 W CASPER DR, PUEBLO WEST, CO 81007-2818
(719) 569-2199
Mailing address
328 W CASPER DR, PUEBLO WEST, CO 81007-2818
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
5214
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5214
CAC III CERTIFICATION NUMBER
CO
Enumeration date
04/01/2010
Last updated
04/01/2010
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