Provider Demographics
NPI:1144571258
Name:IVES, KRISTINE ERIN (LPC, LMFT)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:ERIN
Last Name:IVES
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1243 7TH ST
Mailing Address - Street 2:UNIT C
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-1600
Mailing Address - Country:US
Mailing Address - Phone:303-909-3427
Mailing Address - Fax:
Practice Address - Street 1:1243 7TH ST
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90401-1600
Practice Address - Country:US
Practice Address - Phone:303-909-3427
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-28
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0006149101YM0800X
CALMFT89586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health