Provider Demographics
NPI:1689329096
Name:KREIDER, CLINT N (LMFT)
Entity Type:Individual
Prefix:
First Name:CLINT
Middle Name:N
Last Name:KREIDER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 NEWPORT BLVD STE A109
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-5007
Mailing Address - Country:US
Mailing Address - Phone:949-726-2111
Mailing Address - Fax:
Practice Address - Street 1:2210 PACIFIC AVE UNIT K1
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-4846
Practice Address - Country:US
Practice Address - Phone:949-726-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist