Provider Demographics
NPI:1104100270
Name:CRUSE-GRASSER, KATHLEEN (LPCC-S)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:CRUSE-GRASSER
Suffix:
Gender:F
Credentials:LPCC-S
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:
Other - Last Name:CRUSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:DEPT 781625
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48278-1625
Mailing Address - Country:US
Mailing Address - Phone:614-355-8004
Mailing Address - Fax:614-355-2220
Practice Address - Street 1:500 E MAIN ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-5369
Practice Address - Country:US
Practice Address - Phone:614-355-6340
Practice Address - Fax:614-355-6347
Is Sole Proprietor?:No
Enumeration Date:2011-10-06
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1600068101YP2500X
OHC1400430101YP2500X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1473276Medicaid
OH0205039Medicaid