Kristen Virginia Roudebush, LMFT

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

107108 Issued in CA

Practice address

2050 Broad St
San Luis Obispo, CA 93401-5203

Phone

(805) 441-3845

NPI assigned

Mar 14, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Kris Roudebush Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1124369244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 BROAD ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934015203",
            "telephone_number": "805-441-3845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2050 BROAD ST",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934015203",
            "telephone_number": "805-441-3845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROUDEBUSH",
        "first_name": "KRISTEN",
        "middle_name": "VIRGINIA",
        "name_prefix": "Ms.",
        "credential": "LMFT",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-14",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "107108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRIS",
            "last_name": "ROUDEBUSH",
            "credential": "LMFT",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Danielle Ross, OTR/L
• Gina Elizabeth Ross
• Ryan M Ross, DDS
• Rachel Gibian Rosvold, PT, DPT
• Stephen Gregory Rotondo, M.A.
• Cami Rouse
• Rebecca Row
• Dale W Rowland, M.D.
• Michaela Roy
• RSCR California, Inc

• Marriage & Family Therapist in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.