Healthcare Provider Details

I. General information

NPI: 1467383851
Provider Name (Legal Business Name): ALEXANDRA MARGUERITE KIRK
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST STE 103
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

PO BOX 260803
ENCINO CA
91426-0803
US

V. Phone/Fax

Practice location:
  • Phone: 805-842-1994
  • Fax:
Mailing address:
  • Phone: 818-495-5695
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number157760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: