Provider Demographics
NPI:1659725943
Name:KRELL, RAINA
Entity Type:Individual
Prefix:DR
First Name:RAINA
Middle Name:
Last Name:KRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22111 INDEPENDENCIA ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-5025
Mailing Address - Country:US
Mailing Address - Phone:310-490-9188
Mailing Address - Fax:
Practice Address - Street 1:22111 INDEPENDENCIA ST
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-5025
Practice Address - Country:US
Practice Address - Phone:310-490-9188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPCCI12738101YM0800X
FLMH12568101YM0800X
CA123206500101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool