Provider Demographics
NPI:1942428651
Name:RIALS-SEITZ, CHRIS (MFT INTERN)
Entity Type:Individual
Prefix:MRS
First Name:CHRIS
Middle Name:
Last Name:RIALS-SEITZ
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:MRS
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:SEITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:360 NO SEPULVEDA BVLD
Mailing Address - Street 2:SUITE 2075
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-8638
Mailing Address - Country:US
Mailing Address - Phone:310-414-2090
Mailing Address - Fax:
Practice Address - Street 1:360 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE 2075
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-4460
Practice Address - Country:US
Practice Address - Phone:310-414-2090
Practice Address - Fax:310-414-2096
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45207106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist