Provider Demographics
NPI:1285874214
Name:ANDERSON, KRISTINA M (LMFT)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:M
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9593 HARVEST VISTA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5732
Mailing Address - Country:US
Mailing Address - Phone:612-308-2584
Mailing Address - Fax:
Practice Address - Street 1:9593 HARVEST VISTA DR
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5732
Practice Address - Country:US
Practice Address - Phone:612-308-2584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-04
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1857106H00000X
CALMFT135755106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist