Provider Demographics
NPI:1316196306
Name:BANATHY, KRISTY LYNN
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:LYNN
Last Name:BANATHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTY
Other - Middle Name:LYNN
Other - Last Name:CHAMBERLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8094 PRIMOAK WAY
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95758-7905
Mailing Address - Country:US
Mailing Address - Phone:916-226-6419
Mailing Address - Fax:
Practice Address - Street 1:3440 VIKING DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2844
Practice Address - Country:US
Practice Address - Phone:916-262-8598
Practice Address - Fax:916-262-8599
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-15
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65923106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist