Healthcare Provider Details

I. General information

NPI: 1306214754
Provider Name (Legal Business Name): MISS KRISTAL POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2015
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25171 HIGHWAY 78
RAMONA CA
92065-6304
US

IV. Provider business mailing address

25171 HIGHWAY 78
RAMONA CA
92065-6304
US

V. Phone/Fax

Practice location:
  • Phone: 661-623-2599
  • Fax:
Mailing address:
  • Phone: 661-623-2599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number14256763-3902
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3681803
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT102202
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: