Provider Demographics
NPI:1194038315
Name:KRUSE, LAURA ALISON (MED, BCBA)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:ALISON
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9901 N CAPITAL OF TEXAS HWY
Mailing Address - Street 2:#250
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5852
Mailing Address - Country:US
Mailing Address - Phone:512-887-2126
Mailing Address - Fax:512-949-5027
Practice Address - Street 1:9901 N CAPITAL OF TEXAS HWY
Practice Address - Street 2:#250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5852
Practice Address - Country:US
Practice Address - Phone:512-887-2126
Practice Address - Fax:512-949-5027
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
BCBA 1-06-3115103K00000X
103K00000X
TXBCBA 1-06-3115103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst