1356410591 NPI number — MISS KRISTIN LEANE PERRY MFT

Table of content: MISS KRISTIN LEANE PERRY MFT (NPI 1356410591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356410591 NPI number — MISS KRISTIN LEANE PERRY MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERRY
Provider First Name:
KRISTIN
Provider Middle Name:
LEANE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356410591
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2558 ROOSEVELT ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92008-1672
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-978-6071
Provider Business Mailing Address Fax Number:
760-978-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2558 ROOSEVELT ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92008-1672
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-978-6071
Provider Business Practice Location Address Fax Number:
760-978-6071
Provider Enumeration Date:
11/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  48092 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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