Basic Information
| Provider Information | |||||||||
| NPI: | 1285893602 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRISTO | ||||||||
| FirstName: | CAROLINE | ||||||||
| MiddleName: | Z. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | KRISTO | ||||||||
| OtherFirstName: | CAROLINE | ||||||||
| OtherMiddleName: | Z. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PH.D., LMFT | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 370 9TH ST | ||||||||
| Address2: | |||||||||
| City: | CRESCENT CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 955313432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7074644349 | ||||||||
| FaxNumber: | 7074644572 | ||||||||
| Practice Location | |||||||||
| Address1: | 29995 TECHNOLOGY DR STE 304 | ||||||||
| Address2: | |||||||||
| City: | MURRIETA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925632634 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9519234350 | ||||||||
| FaxNumber: | 9516967292 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2008 | ||||||||
| LastUpdateDate: | 04/27/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 51020 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.