Healthcare Provider Details

I. General information

NPI: 1649791054
Provider Name (Legal Business Name): KRYSTLE STEELEY MA, LMFT 119349
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2017
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W BRIGGSMORE AVE STE I
MODESTO CA
95350-3839
US

IV. Provider business mailing address

PO BOX 1662
CERES CA
95307-8162
US

V. Phone/Fax

Practice location:
  • Phone: 209-522-2167
  • Fax: 209-526-0908
Mailing address:
  • Phone: 209-765-7186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number119349
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: