Provider Demographics
NPI:1114660305
Name:BERGER, KRISTINA HIBSHMAN (MA)
Entity type:Individual
Prefix:MS
First Name:KRISTINA
Middle Name:HIBSHMAN
Last Name:BERGER
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4642
Mailing Address - Country:US
Mailing Address - Phone:805-441-2954
Mailing Address - Fax:
Practice Address - Street 1:1428 PHILLIPS LN STE 202
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2567
Practice Address - Country:US
Practice Address - Phone:805-441-2954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17217101YP2500X
390200000X
CA144595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program