Provider Demographics
NPI:1649791054
Name:STEELEY, KRYSTLE (MA, LMFT 119349)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:STEELEY
Suffix:
Gender:F
Credentials:MA, LMFT 119349
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1662
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-8162
Mailing Address - Country:US
Mailing Address - Phone:209-765-7186
Mailing Address - Fax:
Practice Address - Street 1:2000 W BRIGGSMORE AVE STE I
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-3839
Practice Address - Country:US
Practice Address - Phone:209-522-2167
Practice Address - Fax:209-526-0908
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119349106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist