Provider Demographics
NPI:1447271424
Name:KOMRAUS, BERNIE ELEANOR (LPC, CAC II)
Entity type:Individual
Prefix:MS
First Name:BERNIE
Middle Name:ELEANOR
Last Name:KOMRAUS
Suffix:
Gender:F
Credentials:LPC, CAC II
Other - Prefix:MS
Other - First Name:BERNICE
Other - Middle Name:ELEANOR
Other - Last Name:KOMRAUS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC, CAC II
Mailing Address - Street 1:114 ORCHARD LAKE RD
Mailing Address - Street 2:
Mailing Address - City:PONTIAC
Mailing Address - State:MI
Mailing Address - Zip Code:48341-2244
Mailing Address - Country:US
Mailing Address - Phone:248-858-7766
Mailing Address - Fax:248-858-8227
Practice Address - Street 1:114 ORCHARD LAKE RD
Practice Address - Street 2:
Practice Address - City:PONTIAC
Practice Address - State:MI
Practice Address - Zip Code:48341-2244
Practice Address - Country:US
Practice Address - Phone:248-858-7766
Practice Address - Fax:248-858-8227
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2-00693101YA0400X
MI6401007208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health