Provider Demographics
NPI:1194457291
Name:BRAGG, KRISTEN ANTOINETTE (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:ANTOINETTE
Last Name:BRAGG
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 3003
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-0003
Mailing Address - Country:US
Mailing Address - Phone:855-768-9333
Mailing Address - Fax:650-917-1779
Practice Address - Street 1:1760 THE ALAMEDA STE 100
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1728
Practice Address - Country:US
Practice Address - Phone:408-963-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53534106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist