Provider Demographics
NPI:1356410591
Name:PERRY, KRISTIN LEANE (MFT)
Entity type:Individual
Prefix:MISS
First Name:KRISTIN
Middle Name:LEANE
Last Name:PERRY
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 1:2558 ROOSEVELT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1672
Mailing Address - Country:US
Mailing Address - Phone:760-978-6071
Mailing Address - Fax:760-978-6071
Practice Address - Street 1:2558 ROOSEVELT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-1672
Practice Address - Country:US
Practice Address - Phone:760-978-6071
Practice Address - Fax:760-978-6071
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2011-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48092106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist