Provider Demographics
NPI:1871675181
Name:RUNGE, TAMMY (MFT)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:RUNGE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1408
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1408
Mailing Address - Country:US
Mailing Address - Phone:858-279-1223
Mailing Address - Fax:858-467-7161
Practice Address - Street 1:6475 ALVARADO RD
Practice Address - Street 2:STE. 233
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-5003
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:858-467-7161
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48084106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist