Provider Demographics
NPI:1851517700
Name:GORDON-RAND, KRYSTA R (MS, MFTI)
Entity Type:Individual
Prefix:MS
First Name:KRYSTA
Middle Name:R
Last Name:GORDON-RAND
Suffix:
Gender:F
Credentials:MS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 HAVEN AVE
Mailing Address - Street 2:APT 8-102
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-6958
Mailing Address - Country:US
Mailing Address - Phone:909-969-8133
Mailing Address - Fax:
Practice Address - Street 1:125 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3262
Practice Address - Country:US
Practice Address - Phone:909-986-4550
Practice Address - Fax:909-986-4506
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health