Provider Demographics
NPI:1609121342
Name:KRUEGER, SMITH DEBREY (MA, LMHC)
Entity type:Individual
Prefix:
First Name:SMITH
Middle Name:DEBREY
Last Name:KRUEGER
Suffix:
Gender:
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:HANNAH
Other - Middle Name:
Other - Last Name:KRUEGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMHC
Mailing Address - Street 1:1110 NE JONES RD
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-3922
Mailing Address - Country:US
Mailing Address - Phone:808-631-5731
Mailing Address - Fax:
Practice Address - Street 1:4569 KUKUI ST STE 201
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1775
Practice Address - Country:US
Practice Address - Phone:541-728-3052
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1756-13101YA0400X
HIMHC-375101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)