MEDICARE: KRISTA RENEE PAGE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	142877	CA

General Provider Information

NPI Number	:	1447521695
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTA RENEE PAGE LMFT

Provider Business Mailing Address
First Line	:	PO BOX 514
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90251-0514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2717 S ROBERTSON BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90034-2442
Country	:	US
Telephone Number	:	213-214-6699
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2012
Last Update Date	:	02/08/2024

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