Provider Demographics
NPI:1679242168
Name:TENOVE, KRISTIAN ROSE (LMFT)
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:ROSE
Last Name:TENOVE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KRISTIAN
Other - Middle Name:ROSE
Other - Last Name:ROCKEFELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:14069 HERMOSILLO WAY
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-3931
Mailing Address - Country:US
Mailing Address - Phone:949-735-2067
Mailing Address - Fax:
Practice Address - Street 1:7850 VISTA HILL AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2717
Practice Address - Country:US
Practice Address - Phone:858-836-8544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100278106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist