Provider Demographics
NPI:1124348206
Name:KITTO, CRISPIN (BM)
Entity type:Individual
Prefix:MR
First Name:CRISPIN
Middle Name:
Last Name:KITTO
Suffix:
Gender:M
Credentials:BM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 S WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3160
Mailing Address - Country:US
Mailing Address - Phone:323-578-1251
Mailing Address - Fax:
Practice Address - Street 1:22287 MULHOLLAND HWY
Practice Address - Street 2:#136
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5157
Practice Address - Country:US
Practice Address - Phone:323-578-1251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA68380106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program