Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor |
NPI | 1003253832 |
---|---|
Provider Name | Kristen Elaine Mcdermott |
First Address | Santa Monica, CA 90405-3301 |
Second Address | Santa Monica, CA 90405-3301 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 02/02/2021 |