Provider Demographics
NPI:1255580387
Name:GRUSH, KRISTINE J (LMFT)
Entity type:Individual
Prefix:MS
First Name:KRISTINE
Middle Name:J
Last Name:GRUSH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9171 WILSHIRE BLVD STE 680
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5542
Mailing Address - Country:US
Mailing Address - Phone:310-829-6707
Mailing Address - Fax:310-273-1010
Practice Address - Street 1:9171 WILSHIRE BLVD STE 680
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5542
Practice Address - Country:US
Practice Address - Phone:310-829-6707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist