Provider Demographics
NPI:1548464274
Name:KURTA, JACQUELINE (LMFT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:
Last Name:KURTA
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 1:1013 SAN DIEGO RD
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2135
Mailing Address - Country:US
Mailing Address - Phone:805-963-0915
Mailing Address - Fax:805-963-0917
Practice Address - Street 1:STUDENT HEALTH SERVICES
Practice Address - Street 2:BUILDING 588
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-7002
Practice Address - Country:US
Practice Address - Phone:805-893-8721
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT43222106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist