Provider Demographics
NPI:1063962694
Name:HARVELL, CHRISTINE (MA, LMFT)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:HARVELL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4346 W KLING ST
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-3724
Mailing Address - Country:US
Mailing Address - Phone:818-686-5659
Mailing Address - Fax:
Practice Address - Street 1:1201 S VICTORY BLVD STE 104
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-2552
Practice Address - Country:US
Practice Address - Phone:818-686-5659
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-06
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA109001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFT109001OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCE/LICENSED MARRIAGE AND FAMILY THERAPIST