MEDICARE: MS. PRISCILLA JEAN CONKRITE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	87060	CA

General Provider Information

NPI Number	:	1174799381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PRISCILLA JEAN CONKRITE LMFT

Provider Business Mailing Address
First Line	:	410 E ALVARADO ST
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-4744
Country	:	US
Telephone Number	:	909-967-7391
Fax Number	:

Provider Business Practice Location Address
First Line	:	5216 YARMOUTH AVE UNIT 101
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91316-3124
Country	:	US
Telephone Number	:	909-967-7391
Fax Number	:	909-967-7391

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/07/2008
Last Update Date	:	05/28/2026

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