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General NPI Number Information
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NPI Number | 1376851105
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Entity Type | Individual
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Provider Name | KRISTIN M PERSSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 10/19/2020
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Provider Practice Location Address
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Address Line | 8312 UNIVERSITY AVE
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City | LA MESA
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State | CA
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Zip | 91942-9323
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Country | US
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Telephone | 619-855-2344
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Fax | 619-741-0112
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Provider Business Mailing Address
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Address Line | 8312 UNIVERSITY AVE
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City | LA MESA
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State | CA
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Zip | 91942-9323
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Country | US
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Telephone | 619-855-2344
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Fax | 619-741-0112
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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 | 103TA0700X
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Taxonomy Name | Adult Development & Aging Psychologist
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License Number | PSY23525
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | PSY23525
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY23525
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PSY23525
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License Number State | CA
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23525
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License Number State | CA
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