Healthcare Provider Details

I. General information

NPI: 1083144497
Provider Name (Legal Business Name): KRISTY MALONE MFT, NTP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2017
Last Update Date: 03/09/2020
Certification Date: 03/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 SAXONY RD STE 104
ENCINITAS CA
92024-6776
US

IV. Provider business mailing address

171 SAXONY RD STE 104
ENCINITAS CA
92024-6776
US

V. Phone/Fax

Practice location:
  • Phone: 760-652-9776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number2720
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number94517
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: