Provider Demographics
NPI:1336335157
Name:RUNGE, NATASCHA MARGARETTA
Entity Type:Individual
Prefix:
First Name:NATASCHA
Middle Name:MARGARETTA
Last Name:RUNGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 E KATELLA AVE UNIT 5146
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7911
Mailing Address - Country:US
Mailing Address - Phone:310-951-0654
Mailing Address - Fax:
Practice Address - Street 1:1188 N EUCLID ST # 500
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1900
Practice Address - Country:US
Practice Address - Phone:310-951-0654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-16
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAMFC 50628106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health