Healthcare Provider Details

I. General information

NPI: 1457275729
Provider Name (Legal Business Name): CHRISTINE FUSTON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 FALCON AVE
LONG BEACH CA
90802-4044
US

IV. Provider business mailing address

210 FALCON AVE
LONG BEACH CA
90802-4044
US

V. Phone/Fax

Practice location:
  • Phone: 316-218-8590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY34600
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: