Provider Demographics
NPI:1437365764
Name:RELIS, CHRISTINA EILEEN (LMFT 53317)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:EILEEN
Last Name:RELIS
Suffix:
Gender:F
Credentials:LMFT 53317
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3504
Mailing Address - Street 2:
Mailing Address - City:LOMPOC
Mailing Address - State:CA
Mailing Address - Zip Code:93438-3504
Mailing Address - Country:US
Mailing Address - Phone:805-944-4779
Mailing Address - Fax:805-800-0608
Practice Address - Street 1:104 S C ST STE H
Practice Address - Street 2:
Practice Address - City:LOMPOC
Practice Address - State:CA
Practice Address - Zip Code:93436-6924
Practice Address - Country:US
Practice Address - Phone:805-944-4779
Practice Address - Fax:805-800-0608
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53317106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist