Provider Demographics
NPI:1164048955
Name:CLANCY, KRISTINA KALAYA (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KALAYA
Last Name:CLANCY
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 1:8937 TRAILRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTEE
Mailing Address - State:CA
Mailing Address - Zip Code:92071-2051
Mailing Address - Country:US
Mailing Address - Phone:850-240-4046
Mailing Address - Fax:
Practice Address - Street 1:2333 1ST AVE STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-1540
Practice Address - Country:US
Practice Address - Phone:619-841-1428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-17
Last Update Date:2020-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist