Provider Demographics
NPI:1902228315
Name:KOUSAKIS, CHRISTINA SAVALAS (MFT)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:SAVALAS
Last Name:KOUSAKIS
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 1:11340 W OLYMPIC BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1612
Mailing Address - Country:US
Mailing Address - Phone:310-736-5665
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD STE 210
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1612
Practice Address - Country:US
Practice Address - Phone:310-736-5665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-20
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48942103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical