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NPI Code Detail

MEDICARE: KRISTINA D BIRCH LPCC

MEDICARE: KRISTINA D BIRCH LPCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YP2500XProfessional CounselorLPCCCA
3101YP2500XProfessional Counselor6636CA

General Provider Information

NPI Number : 1366874844
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTINA D BIRCH LPCC
Provider Business Mailing Address
First Line : 1256 W LATHROP RD
Second Line :
City : MANTECA
State : CA
Zip : 95336-9671
Country : US
Telephone Number : 209-426-0962
Fax Number :
Provider Business Practice Location Address
First Line : 1141 LEVER BLVD
Second Line :
City : STOCKTON
State : CA
Zip : 95206-2855
Country : US
Telephone Number : 209-933-7000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/06/2013
Last Update Date : 10/11/2024

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Directions to “ KRISTINA D BIRCH LPCC” Practice Location

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