Healthcare Provider Details

I. General information

NPI: 1588481469
Provider Name (Legal Business Name): CHRISTINA KAUFMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11845 W OLYMPIC BLVD STE 1250W
LOS ANGELES CA
90064-1149
US

IV. Provider business mailing address

11845 W OLYMPIC BLVD STE 1250W
LOS ANGELES CA
90064-1149
US

V. Phone/Fax

Practice location:
  • Phone: 310-596-1776
  • Fax:
Mailing address:
  • Phone: 310-596-1776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number111533
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number111533
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number111533
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: