Basic Information
Provider Information | |||||||||
NPI: | 1952727935 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HEWLETT | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | M | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1977 N GAREY AVE | ||||||||
Address2: | SUITE 6 | ||||||||
City: | POMONA | ||||||||
State: | CA | ||||||||
PostalCode: | 917672774 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9096236651 | ||||||||
FaxNumber: | 9096230455 | ||||||||
Practice Location | |||||||||
Address1: | 6267 VARIEL AVE | ||||||||
Address2: | SUITE B | ||||||||
City: | WOODLAND HILLS | ||||||||
State: | CA | ||||||||
PostalCode: | 91367 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8186570411 | ||||||||
FaxNumber: | 8186570406 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/13/2014 | ||||||||
LastUpdateDate: | 07/05/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | LMFT91513 | CA | Y |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   | 106H00000X | 71551 | CA | N |   | Behavioral Health & Social Service Providers | Marriage & Family Therapist |   |
No ID Information.