Provider Demographics
NPI:1306146113
Name:OBER, KRISTEN M (MFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:M
Last Name:OBER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24591 DEL PRADO
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-3837
Mailing Address - Country:US
Mailing Address - Phone:949-374-8760
Mailing Address - Fax:
Practice Address - Street 1:24591 DEL PRADO
Practice Address - Street 2:SUITE 201
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3837
Practice Address - Country:US
Practice Address - Phone:949-374-8760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-26
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47512106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist