Provider Demographics
NPI:1730198334
Name:KIRBY, KRISTIN DEWELL (MFT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:DEWELL
Last Name:KIRBY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 AARON CIR
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95687-6905
Mailing Address - Country:US
Mailing Address - Phone:707-365-9246
Mailing Address - Fax:
Practice Address - Street 1:272 AARON CIR
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95687-6905
Practice Address - Country:US
Practice Address - Phone:707-365-9246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48653106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist