Provider Demographics
NPI:1245517028
Name:GARUBBA, KRISTEN I (MFT)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:I
Last Name:GARUBBA
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 1:1171 CHERI DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2601
Mailing Address - Country:US
Mailing Address - Phone:562-245-7282
Mailing Address - Fax:562-697-8274
Practice Address - Street 1:1171 CHERI DR
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2601
Practice Address - Country:US
Practice Address - Phone:562-245-7282
Practice Address - Fax:562-697-8274
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62196106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist