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General NPI Number Information
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NPI Number | 1407780638
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Entity Type | Individual
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Provider Name | KIRSTEN L JACKSON
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Gender | Female
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Dates
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Enumeration Date | 06/11/2026
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Last Update Date | 06/14/2026
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Provider Practice Location Address
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Address Line | 9713 SANTA MONICA BLVD STE 201
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4236
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Country | US
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Telephone | 323-486-3014
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3023
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City | GLENDALE
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State | CA
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Zip | 91221-0023
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Country | US
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Telephone | 818-588-6278
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT-158791
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License Number State | CA
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