Provider Demographics
NPI:1609090562
Name:HERBERT, KRYSTLE GAIL (LMFT, PSYD ABD)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:GAIL
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LMFT, PSYD ABD
Other - Prefix:
Other - First Name:KRYSTLE
Other - Middle Name:GAIL
Other - Last Name:HAYS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT, PSYD ABD
Mailing Address - Street 1:5032 INADALE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90043-1514
Mailing Address - Country:US
Mailing Address - Phone:310-968-2364
Mailing Address - Fax:323-792-4867
Practice Address - Street 1:12777 WEST JEFFERSON BLVD
Practice Address - Street 2:BUILDING D, #300
Practice Address - City:PLAYA VISTA
Practice Address - State:CA
Practice Address - Zip Code:90066
Practice Address - Country:US
Practice Address - Phone:323-696-0386
Practice Address - Fax:323-792-4867
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF48571101YA0400X, 106H00000X
101YA0400X, 225400000X
CALMFT 80484106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner