Provider Demographics
NPI:1952037327
Name:MAESTAS, KRYSTLE (LCPC-C)
Entity Type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LCPC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 1/4 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1729
Mailing Address - Country:US
Mailing Address - Phone:323-774-2667
Mailing Address - Fax:
Practice Address - Street 1:637 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106-6425
Practice Address - Country:US
Practice Address - Phone:207-874-2141
Practice Address - Fax:207-874-2164
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC14357101YP2500X
MEXL6703101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAPCC14357OtherCALIFORNIA BOARD OF BEHAVORIAL SCIENCES