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General NPI Number Information
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NPI Number | 1780468389
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Entity Type | Organization
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Legal Business Name | KIRSTEN ANGELIYAN MARRIAGE AND FAMILY THERAPY, PROFESSIONAL CORPORATIO
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Dates
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Enumeration Date | 08/23/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 4103 BERNARDO DR
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6250
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Country | US
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Telephone | 805-996-0828
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Fax |
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Provider Business Mailing Address
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Address Line | 4103 BERNARDO DR
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-6250
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | KIRSTEN LARSEN ANGELIYAN
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Credential | LMFT
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Telephone | 805-996-0828
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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 |
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License Number State |
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