Healthcare Provider Details

I. General information

NPI: 1154917235
Provider Name (Legal Business Name): KRUG AND PARK FAMILY COUNSELING PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5360 JACKSON DR STE 220C
LA MESA CA
91942-6002
US

IV. Provider business mailing address

PO BOX 711742
SANTEE CA
92072-1742
US

V. Phone/Fax

Practice location:
  • Phone: 619-353-0818
  • Fax: 619-333-4525
Mailing address:
  • Phone: 858-342-0501
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: KATHRYN D KRUG
Title or Position: OWNER/FOUNDER
Credential: LMFT
Phone: 619-353-0818