Provider Demographics
NPI:1154824811
Name:KRUG, ORAH (PHD, MFT)
Entity type:Individual
Prefix:
First Name:ORAH
Middle Name:
Last Name:KRUG
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:DR
Other - First Name:ORAH
Other - Middle Name:
Other - Last Name:KRUG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:5655 COLLEGE AVE STE 315E
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1669
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5655 COLLEGE AVE STE 315E
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1669
Practice Address - Country:US
Practice Address - Phone:510-287-9350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-08
Last Update Date:2018-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist