Provider Demographics
NPI:1730466699
Name:ELBERT, KRISTY NICOLE
Entity Type:Individual
Prefix:MS
First Name:KRISTY
Middle Name:NICOLE
Last Name:ELBERT
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 1:940 E VALLEY PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-3441
Mailing Address - Country:US
Mailing Address - Phone:760-747-0205
Mailing Address - Fax:760-747-0582
Practice Address - Street 1:940 E VALLEY PKWY STE D
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3441
Practice Address - Country:US
Practice Address - Phone:760-747-0205
Practice Address - Fax:760-747-0582
Is Sole Proprietor?:No
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health