Provider Demographics
NPI:1659582534
Name:EDMONDS-BIGLOW, KRYSTEL TERISE (PSY D)
Entity Type:Individual
Prefix:MRS
First Name:KRYSTEL
Middle Name:TERISE
Last Name:EDMONDS-BIGLOW
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5757 W CENTURY BLVD STE 700
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-6409
Mailing Address - Country:US
Mailing Address - Phone:323-369-1292
Mailing Address - Fax:
Practice Address - Street 1:5757 W CENTURY BLVD STE 700
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-6409
Practice Address - Country:US
Practice Address - Phone:323-369-1292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19260103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical