Healthcare Provider Details

I. General information

NPI: 1609090562
Provider Name (Legal Business Name): KRYSTLE GAIL HERBERT LMFT, PSYD ABD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRYSTLE GAIL HAYS LMFT, PSYD ABD

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12777 WEST JEFFERSON BLVD BUILDING D, #300
PLAYA VISTA CA
90066
US

IV. Provider business mailing address

5032 INADALE AVE
LOS ANGELES CA
90043-1514
US

V. Phone/Fax

Practice location:
  • Phone: 323-696-0386
  • Fax: 323-792-4867
Mailing address:
  • Phone: 310-968-2364
  • Fax: 323-792-4867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberIMF48571
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF48571
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT 80484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: