Provider Demographics
NPI:1508984386
Name:MALKA, KRISTIN RENE' (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:RENE'
Last Name:MALKA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KRISTIN
Other - Middle Name:RENE'
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:13543 MOORPARK ST APT 5
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3804
Mailing Address - Country:US
Mailing Address - Phone:818-268-3432
Mailing Address - Fax:
Practice Address - Street 1:15317 RAYEN ST
Practice Address - Street 2:
Practice Address - City:NORTH HILLS
Practice Address - State:CA
Practice Address - Zip Code:91343-5117
Practice Address - Country:US
Practice Address - Phone:818-892-4323
Practice Address - Fax:818-893-4509
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201289106H00000X
CA46027106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-2633765OtherMEDI-CAL