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General NPI Number Information
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NPI Number | 1770952103
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Entity Type | Individual
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Provider Name | JAMIE KIRK
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Gender | Female
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 12/12/2022
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Provider Practice Location Address
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Address Line | 1245 S LA BREA AVE STE 197
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City | INGLEWOOD
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State | CA
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Zip | 90301-3821
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Country | US
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Telephone | 951-258-5907
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Fax |
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Provider Business Mailing Address
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Address Line | 2208 HANFRED LN # 101-199
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City | TUCKER
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State | GA
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Zip | 30084-4810
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Country | US
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Telephone | 951-258-5907
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 136013
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License Number State | CA
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