Healthcare Provider Details

I. General information

NPI: 1174799381
Provider Name (Legal Business Name): PRISCILLA JEAN CONKRITE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5216 YARMOUTH AVE UNIT 101
ENCINO CA
91316-3124
US

IV. Provider business mailing address

410 E ALVARADO ST
POMONA CA
91767-4744
US

V. Phone/Fax

Practice location:
  • Phone: 909-967-7391
  • Fax: 909-967-7391
Mailing address:
  • Phone: 909-967-7391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number87060
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: