Provider Demographics
NPI:1073097325
Name:MOURAD, CHRISTINE ANNE (LMFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:ANNE
Last Name:MOURAD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-0093
Mailing Address - Country:US
Mailing Address - Phone:818-835-4399
Mailing Address - Fax:
Practice Address - Street 1:1247 7TH ST STE 202
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1643
Practice Address - Country:US
Practice Address - Phone:818-835-4399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-22
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA108128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health