Provider Demographics
NPI:1902314529
Name:LARKIN, KYRAH BRITTANI
Entity Type:Individual
Prefix:MISS
First Name:KYRAH
Middle Name:BRITTANI
Last Name:LARKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 GLENGYLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90604-2434
Mailing Address - Country:US
Mailing Address - Phone:562-777-1222
Mailing Address - Fax:
Practice Address - Street 1:14100 GLENGYLE ST
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90604-2434
Practice Address - Country:US
Practice Address - Phone:562-777-1222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-17
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0000000000Medicaid