Provider Demographics
NPI:1205026077
Name:BERNOUS, CHRISTAL (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTAL
Middle Name:
Last Name:BERNOUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CHRISTAL
Other - Middle Name:RUTH
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1451 QUAIL ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2742
Mailing Address - Country:US
Mailing Address - Phone:714-345-7235
Mailing Address - Fax:
Practice Address - Street 1:1451 QUAIL ST
Practice Address - Street 2:SUITE 102
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2742
Practice Address - Country:US
Practice Address - Phone:714-345-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-27
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14682103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical