Provider Demographics
NPI:1952037327
Name:MAESTAS, KRYSTLE (LPCC)
Entity type:Individual
Prefix:
First Name:KRYSTLE
Middle Name:
Last Name:MAESTAS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3332 1/4 ALICE ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-1729
Mailing Address - Country:US
Mailing Address - Phone:323-774-2667
Mailing Address - Fax:
Practice Address - Street 1:284 CUMBERLAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4927
Practice Address - Country:US
Practice Address - Phone:207-874-2141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEXL6703101YP2500X
CA17544101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALPCC17544OtherCALIFORNIA BOARD OF BEHAVORIAL SCIENCES