Provider Demographics
NPI:1174643696
Name:KRAISS, YVETTE LEILA (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:YVETTE
Middle Name:LEILA
Last Name:KRAISS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 MAIN ST
Mailing Address - Street 2:#446
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3803
Mailing Address - Country:US
Mailing Address - Phone:818-636-4883
Mailing Address - Fax:
Practice Address - Street 1:214 MAIN ST
Practice Address - Street 2:#446
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3803
Practice Address - Country:US
Practice Address - Phone:818-636-4883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45679106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist