Provider Demographics
NPI:1598904070
Name:DEPENBROK, KRISTA L (MFT)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:L
Last Name:DEPENBROK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 S DONOVAN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-3253
Mailing Address - Country:US
Mailing Address - Phone:925-828-1900
Mailing Address - Fax:
Practice Address - Street 1:171 FRONT ST
Practice Address - Street 2:SUITE 204
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3347
Practice Address - Country:US
Practice Address - Phone:415-307-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist