MEDICARE: KRISTINE A ELGIN 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	89380	CA

General Provider Information

NPI Number	:	1790801025
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINE A ELGIN LMFT

Provider Business Mailing Address
First Line	:	4515 PALMERO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-4236
Country	:	US
Telephone Number	:	323-378-7781
Fax Number	:

Provider Business Practice Location Address
First Line	:	4515 PALMERO DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-4236
Country	:	US
Telephone Number	:	323-378-7781
Fax Number	:

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

Provider Enumeration Date	:	03/21/2007
Last Update Date	:	09/01/2025

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