Provider Demographics
NPI:1205685542
Name:ORRELL, KRISTA LEE
Entity type:Individual
Prefix:
First Name:KRISTA
Middle Name:LEE
Last Name:ORRELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KRISTA
Other - Middle Name:LEE
Other - Last Name:KLADDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27209 TERRA VIS
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-8280
Mailing Address - Country:US
Mailing Address - Phone:951-813-8396
Mailing Address - Fax:
Practice Address - Street 1:1370 S STATE ST STE B
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92583-4922
Practice Address - Country:US
Practice Address - Phone:951-791-3596
Practice Address - Fax:951-791-3397
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical