Provider Demographics
NPI:1164690343
Name:EVERETT, KRISTEN (LMFT 88718)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:EVERETT
Suffix:
Gender:F
Credentials:LMFT 88718
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 GORDON ST
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94061-2810
Mailing Address - Country:US
Mailing Address - Phone:650-469-3809
Mailing Address - Fax:
Practice Address - Street 1:1623 GORDON ST
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-2810
Practice Address - Country:US
Practice Address - Phone:650-469-3809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA88718106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program