Provider Demographics
NPI:1346792298
Name:ELISABETH KRAUSE
Entity type:Organization
Organization Name:ELISABETH KRAUSE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:P
Authorized Official - Last Name:KRAUSE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:307-462-9597
Mailing Address - Street 1:65 N, GRANIER AVE
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC CITY
Mailing Address - State:WY
Mailing Address - Zip Code:82520
Mailing Address - Country:US
Mailing Address - Phone:307-462-9597
Mailing Address - Fax:
Practice Address - Street 1:65 N, GRANIER AVE
Practice Address - Street 2:
Practice Address - City:ATLANTIC CITY
Practice Address - State:WY
Practice Address - Zip Code:82520
Practice Address - Country:US
Practice Address - Phone:307-462-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLPC-1217261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY142138700Medicaid