Provider Demographics
NPI:1336469212
Name:DANCY, KRYSTA (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KRYSTA
Middle Name:
Last Name:DANCY
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:KRYSTA
Other - Middle Name:
Other - Last Name:DANCY-CABEAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:720 SUNRISE AVE
Mailing Address - Street 2:SUITE D115
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4516
Mailing Address - Country:US
Mailing Address - Phone:916-270-7413
Mailing Address - Fax:
Practice Address - Street 1:720 SUNRISE AVE
Practice Address - Street 2:SUITE D115
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4516
Practice Address - Country:US
Practice Address - Phone:916-270-7413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48506101Y00000X, 101YM0800X, 101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional