Healthcare Provider Details

I. General information

NPI: 1003085143
Provider Name (Legal Business Name): KRISTIN MAYTUBBY PSY.D., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5558 CALIFORNIA AVE STE 100
BAKERSFIELD CA
93309-0710
US

IV. Provider business mailing address

5558 CALIFORNIA AVE STE 100
BAKERSFIELD CA
93309-0710
US

V. Phone/Fax

Practice location:
  • Phone: 661-379-0173
  • Fax:
Mailing address:
  • Phone: 661-379-0173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number33978
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26467
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: