Provider Demographics
NPI:1598182636
Name:KHALAF, KRYSTLE J (LCSW)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:J
Last Name:KHALAF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:J
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:825 S MYRTLE AVE UNIT 313
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-8612
Mailing Address - Country:US
Mailing Address - Phone:626-627-0837
Mailing Address - Fax:
Practice Address - Street 1:1500 DUARTE RD
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3012
Practice Address - Country:US
Practice Address - Phone:626-218-1795
Practice Address - Fax:626-930-5331
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2022-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1075021041C0700X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program