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General NPI Number Information
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NPI Number | 1104998368
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Entity Type | Organization
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Legal Business Name | CHILD & FAMILY PSYCHOLOGY CLINIC
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5500 MING AVE SUITE 120
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4689
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Country | US
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Telephone | 661-833-5890
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Fax | 661-833-5892
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Provider Business Mailing Address
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Address Line | 5500 MING AVE SUITE 120
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City | BAKERSFIELD
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State | CA
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Zip | 93309-4689
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Country | US
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Telephone | 661-833-5890
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Fax | 661-833-5892
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL EARL KIRK
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Credential | PH.D
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Telephone | 661-833-5890
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY13717
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License Number State | CA
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