Healthcare Provider Details

I. General information

NPI: 1235276080
Provider Name (Legal Business Name): KATHERINE ANN KIRK MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 04/02/2021
Certification Date: 04/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 N BERETANIA STREET 2402
HONOLULU HI
96817-4760
US

IV. Provider business mailing address

60 N BERETANIA STREET 2402
HONOLULU HI
96817-4760
US

V. Phone/Fax

Practice location:
  • Phone: 808-215-9174
  • Fax: 808-465-3261
Mailing address:
  • Phone: 808-215-9174
  • Fax: 707-313-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC297
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC46475
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFT396
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: