Provider Demographics
NPI:1467907675
Name:KRUGER, THERESA DIANE (LMFT)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANE
Last Name:KRUGER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:KRUGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1921 S CATALINA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5516
Mailing Address - Country:US
Mailing Address - Phone:310-529-9956
Mailing Address - Fax:310-952-2559
Practice Address - Street 1:1921 S CATALINA AVE STE 1
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5516
Practice Address - Country:US
Practice Address - Phone:310-529-9956
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 88849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist