Provider Demographics
NPI:1073310975
Name:CRIST, MYNDY (LMFT)
Entity type:Individual
Prefix:MS
First Name:MYNDY
Middle Name:
Last Name:CRIST
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2778 LAKEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2619
Mailing Address - Country:US
Mailing Address - Phone:213-434-1196
Mailing Address - Fax:
Practice Address - Street 1:2502 HYPERION AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-3317
Practice Address - Country:US
Practice Address - Phone:424-291-2443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-27
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist