Provider Demographics
NPI:1730310640
Name:ROWE, KRYSTLE LYNN (PHD, LMFT)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:LYNN
Last Name:ROWE
Suffix:
Gender:F
Credentials:PHD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE STE 228
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2633
Mailing Address - Country:US
Mailing Address - Phone:909-815-9553
Mailing Address - Fax:
Practice Address - Street 1:7177 BROCKTON AVE STE 228
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2633
Practice Address - Country:US
Practice Address - Phone:909-815-9563
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60589106H00000X
CA50964106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist