MEDICARE: MS. KRISTY FLETCHER AMFT 114855

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	101YA0400X	Addiction (Substance Use Disorder) Counselor		CA
2	106H00000X	Marriage & Family Therapist	114855	CA

General Provider Information

NPI Number	:	1851816300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTY FLETCHER AMFT 114855

Provider Business Mailing Address
First Line	:	1425 N LOS ROBLES AVE APT 3
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-2142
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4221 WILSHIRE BLVD STE 170-16
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3519
Country	:	US
Telephone Number	:	213-441-6780
Fax Number	:

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

Provider Enumeration Date	:	08/06/2017
Last Update Date	:	05/11/2021

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