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General NPI Number Information
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NPI Number | 1164048955
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Entity Type | Individual
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Provider Name | KRISTINA KALAYA CLANCY LMFT
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Gender | Female
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Dates
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Enumeration Date | 06/17/2020
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Last Update Date | 06/17/2020
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Provider Practice Location Address
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Address Line | 2333 1ST AVE STE 203
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City | SAN DIEGO
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State | CA
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Zip | 92101-1540
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Country | US
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Telephone | 619-841-1428
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Fax |
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Provider Business Mailing Address
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Address Line | 8937 TRAILRIDGE AVE
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City | SANTEE
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State | CA
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Zip | 92071-2051
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Country | US
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Telephone | 850-240-4046
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 119299
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License Number State | CA
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