Provider Demographics
NPI:1366825663
Name:ROPER, KRISTEL (LMFT, LPCC)
Entity Type:Individual
Prefix:MISS
First Name:KRISTEL
Middle Name:
Last Name:ROPER
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9821 FAIR OAKS BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-7050
Mailing Address - Country:US
Mailing Address - Phone:530-424-8636
Mailing Address - Fax:
Practice Address - Street 1:9821 FAIR OAKS BLVD STE B
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7050
Practice Address - Country:US
Practice Address - Phone:530-424-8636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC6649101YM0800X
CALMFT107976106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health