Provider Demographics
NPI:1851426100
Name:RUDY, KRYSTEN MICHELE (MFT)
Entity Type:Individual
Prefix:
First Name:KRYSTEN
Middle Name:MICHELE
Last Name:RUDY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3511 CAMINO DEL RIO S
Mailing Address - Street 2:SUITE 500
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4003
Mailing Address - Country:US
Mailing Address - Phone:858-583-3186
Mailing Address - Fax:
Practice Address - Street 1:3511 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 500
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4003
Practice Address - Country:US
Practice Address - Phone:858-869-4128
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43038106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist