Healthcare Provider Details

I. General information

NPI: 1518884428
Provider Name (Legal Business Name): KRISTIN LAWRENCE AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 N EL CAMINO REAL STE 216
SAN CLEMENTE CA
92672-4778
US

IV. Provider business mailing address

3649 MERCED DR
OCEANSIDE CA
92056-5481
US

V. Phone/Fax

Practice location:
  • Phone: 619-363-2202
  • Fax:
Mailing address:
  • Phone: 408-475-3550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number164125
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: