Provider Demographics
NPI:1467907675
Name:KRUGER, THERESA DIANE (LMFT)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:DIANE
Last Name:KRUGER
Suffix:
Gender:
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 1:600 YARMOUTH RD UNIT B
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-2652
Mailing Address - Country:US
Mailing Address - Phone:310-529-9956
Mailing Address - Fax:310-982-2559
Practice Address - Street 1:600 YARMOUTH RD UNIT B
Practice Address - Street 2:
Practice Address - City:PALOS VERDES ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-2652
Practice Address - Country:US
Practice Address - Phone:310-529-9956
Practice Address - Fax:310-982-2559
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 88849106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100173132Medicaid