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General NPI Number Information
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NPI Number | 1851203848
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Entity Type | Individual
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Provider Name | KRISTOPHER RILEY STATHAM PPSC, CWC II
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Gender | Male
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Dates
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Enumeration Date | 09/22/2026
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Last Update Date | 09/22/2026
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Provider Practice Location Address
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Address Line | 11601 MAIN ST
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City | SUNOL
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State | CA
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Zip | 94586-9519
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Country | US
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Telephone | 669-241-0420
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Fax |
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Provider Business Mailing Address
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Address Line | 407 SANCHEZ ST APT 2150
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City | SAN FRANCISCO
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State | CA
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Zip | 94114-2080
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Country | US
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Telephone |
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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 | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number | BA0F6A6A74
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 260077394
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License Number State | CA
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