Healthcare Provider Details

I. General information

NPI: 1821471699
Provider Name (Legal Business Name): KRISTEN WIXTED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2015
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3080 WINCHESTER DR
RESCUE CA
95672-9688
US

IV. Provider business mailing address

3080 WINCHESTER DR
RESCUE CA
95672-9688
US

V. Phone/Fax

Practice location:
  • Phone: 530-417-6369
  • Fax:
Mailing address:
  • Phone: 530-417-6369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: