Provider Demographics
NPI:1750757530
Name:CHAN, SARINA CRYSTAL (LMFT)
Entity type:Individual
Prefix:
First Name:SARINA
Middle Name:CRYSTAL
Last Name:CHAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SARINA
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1490 N CLAREMONT BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3519
Mailing Address - Country:US
Mailing Address - Phone:909-500-8509
Mailing Address - Fax:
Practice Address - Street 1:1490 N CLAREMONT BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3519
Practice Address - Country:US
Practice Address - Phone:909-500-8509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-17
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA97746106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist