Healthcare Provider Details

I. General information

NPI: 1679592935
Provider Name (Legal Business Name): KIRSTEN HERMANN L.M.F.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4686 CORRALES RD
CORRALES NM
87048-8610
US

IV. Provider business mailing address

PO BOX 2952
CORRALES NM
87048-2952
US

V. Phone/Fax

Practice location:
  • Phone: 505-899-3544
  • Fax: 815-346-2321
Mailing address:
  • Phone: 505-899-3544
  • Fax: 815-346-2321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number0069212
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: