Healthcare Provider Details

I. General information

NPI: 1891904777
Provider Name (Legal Business Name): MARIA GUADALUPE LOPEZ KIRKLIN PHD, MS, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GUADALUPE LOPEZ KIRKLIN

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 LAWS AVE
UKIAH CA
95482-6540
US

IV. Provider business mailing address

830 MOHAWK DR
UKIAH CA
95482-5152
US

V. Phone/Fax

Practice location:
  • Phone: 707-468-1010
  • Fax:
Mailing address:
  • Phone: 805-701-9894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number125004
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberT3234
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: