Healthcare Provider Details

I. General information

NPI: 1538478003
Provider Name (Legal Business Name): KRISTINA GRACE HUDDLESTON MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 21ST ST # 6648
SACRAMENTO CA
95811-5226
US

IV. Provider business mailing address

1609 MAYO ST APT A
RIDGECREST CA
93555-8812
US

V. Phone/Fax

Practice location:
  • Phone: 760-618-6581
  • Fax:
Mailing address:
  • Phone: 702-600-1519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number2582
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: