Active NPI
Mary Jane Kruse, MA, CAC III
- Addiction (Substance Use Disorder) Counselor
- Pueblo West, CO
National Provider Identifier
1972828036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction (Substance Use Disorder) Counselor
- License
- 5214
- Practice address
- 328 W Casper Dr
Pueblo West, CO 81007-2818 - Phone
- (719) 569-2199
- NPI assigned
- Apr 1, 2010
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 5214 | CO | Primary |
Addresses
Primary practice location
328 W Casper Dr
Pueblo West, CO 81007-2818
Mailing address
328 W Casper Dr
Pueblo West, CO 81007-2818
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5214 | Other | CO | CAC III CERTIFICATION NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 5214 | CO | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270080000000",
"number": "1972828036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "328 W CASPER DR",
"city": "PUEBLO WEST",
"state": "CO",
"postal_code": "810072818"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "328 W CASPER DR",
"city": "PUEBLO WEST",
"state": "CO",
"postal_code": "810072818",
"telephone_number": "719-569-2199"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KRUSE",
"first_name": "MARY",
"middle_name": "JANE",
"credential": "MA, CAC III",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2010-04-01",
"last_updated": "2010-04-01",
"status": "A"
},
"taxonomies": [
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "CO",
"license": "5214",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAC III CERTIFICATION NUMBER",
"identifier": "5214",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pueblo West, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.