MEDICARE: CHRISTAL-JOI WHITAKER MA, 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	MFC50270	CA

General Provider Information

NPI Number	:	1902937816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTAL-JOI WHITAKER MA, LMFT

Provider Business Mailing Address
First Line	:	46E PENINSULA CENTER
Second Line	:	#197
City	:	ROLLING HILLS
State	:	CA
Zip	:	90274-1384
Country	:	US
Telephone Number	:	855-252-3022
Fax Number	:	855-252-3022

Provider Business Practice Location Address
First Line	:	46E PENINSULA CENTER
Second Line	:	#197
City	:	ROLLING HILLS
State	:	CA
Zip	:	90274-9027
Country	:	US
Telephone Number	:	855-252-3022
Fax Number	:	855-252-3022

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

Provider Enumeration Date	:	03/09/2007
Last Update Date	:	07/23/2020

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