Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 106E00000X | Assistant Behavior Analyst | 0-21-13255 |
NPI | 1104486828 |
---|---|
Provider Name | Marcus Krause |
First Address | Colorado Springs, CO 80906-4651 |
Second Address | Colorado Springs, CO 80906-4651 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2019 |
Last Update Date | 14/12/2021 |