Provider Demographics
NPI:1407393416
Name:KRBR CORPORATION
Entity Type:Organization
Organization Name:KRBR CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MISS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:ROUTH
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:805-657-5520
Mailing Address - Street 1:PO BOX 19328
Mailing Address - Street 2:
Mailing Address - City:NEWBURY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91319-9328
Mailing Address - Country:US
Mailing Address - Phone:805-657-5520
Mailing Address - Fax:805-309-5204
Practice Address - Street 1:31822 VILLAGE CENTER RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4316
Practice Address - Country:US
Practice Address - Phone:805-657-5520
Practice Address - Fax:805-309-5204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-27
Last Update Date:2017-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52149106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty