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General NPI Number Information
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NPI Number | 1952033730
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Entity Type | Organization
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Legal Business Name | KRISTEN GARDENHIRE
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Dates
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Enumeration Date | 06/29/2022
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Last Update Date | 06/30/2022
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Provider Practice Location Address
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Address Line | 11870 SANTA MONICA BLVD # 106381
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City | LOS ANGELES
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State | CA
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Zip | 90025-2276
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Country | US
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Telephone | 323-205-6559
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Fax |
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Provider Business Mailing Address
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Address Line | 11870 SANTA MONICA BLVD # 106381
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City | LOS ANGELES
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State | CA
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Zip | 90025-2276
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Country | US
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Telephone | 323-205-6559
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KRISTEN MIHARA
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Credential |
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Telephone | 323-205-6559
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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