Healthcare Provider Details

I. General information

NPI: 1942968961
Provider Name (Legal Business Name): KRISTYN MARIE BECKSTROM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2021
Last Update Date: 12/07/2021
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 3RD ST
ENCINITAS CA
92024-3556
US

IV. Provider business mailing address

145 STONESTEPS WAY
ENCINITAS CA
92024-1591
US

V. Phone/Fax

Practice location:
  • Phone: 858-692-8234
  • Fax:
Mailing address:
  • Phone: 858-692-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number128484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: