Provider Demographics
NPI:1790469757
Name:KREGER, LAURIE LAURRAINE (MHC)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:LAURRAINE
Last Name:KREGER
Suffix:
Gender:F
Credentials:MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 SIMMONS LN
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945-1735
Mailing Address - Country:US
Mailing Address - Phone:707-328-5594
Mailing Address - Fax:
Practice Address - Street 1:1109 SIR FRANCIS DR
Practice Address - Street 2:
Practice Address - City:KENTFIELD
Practice Address - State:CA
Practice Address - Zip Code:94904-1418
Practice Address - Country:US
Practice Address - Phone:707-328-5594
Practice Address - Fax:707-328-5594
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-12
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty