Healthcare Provider Details

I. General information

NPI: 1134216401
Provider Name (Legal Business Name): CARLA KUKLINSKY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

922A STATE STREET STE 3
SANTA BARBARA CA
93101-2770
US

IV. Provider business mailing address

922A STATE STREET #3
SANTA BARBARA CA
93101-2770
US

V. Phone/Fax

Practice location:
  • Phone: 805-962-1129
  • Fax:
Mailing address:
  • Phone: 805-962-1129
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFT 32432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: