Provider Demographics
NPI:1356673057
Name:KRUSE, DOROTHY A (MA, MFT)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:A
Last Name:KRUSE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 MAYHEW WAY
Mailing Address - Street 2:SUITE 702
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4328
Mailing Address - Country:US
Mailing Address - Phone:924-465-3899
Mailing Address - Fax:925-943-3916
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:SUITE 702
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4328
Practice Address - Country:US
Practice Address - Phone:924-465-3899
Practice Address - Fax:925-943-3916
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-04
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35063106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist