Provider Demographics
NPI:1720211873
Name:DE LEON, KRISTY ANNE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:KRISTY
Middle Name:ANNE
Last Name:DE LEON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-6420
Mailing Address - Country:US
Mailing Address - Phone:949-424-3298
Mailing Address - Fax:
Practice Address - Street 1:620 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-6420
Practice Address - Country:US
Practice Address - Phone:949-424-3298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-24
Last Update Date:2015-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85520106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist