Provider Demographics
NPI:1588041487
Name:TISSOT, CRISTINA (LMFT)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:TISSOT
Suffix:
Gender:F
Credentials:LMFT
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 543
Mailing Address - Street 2:
Mailing Address - City:DOUGLAS CITY
Mailing Address - State:CA
Mailing Address - Zip Code:96024-0543
Mailing Address - Country:US
Mailing Address - Phone:530-739-2983
Mailing Address - Fax:
Practice Address - Street 1:493 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEAVERVILLE
Practice Address - State:CA
Practice Address - Zip Code:96093
Practice Address - Country:US
Practice Address - Phone:530-739-2983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86426106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist