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NPI Code Detail

MEDICARE: KIRSTEN NOEL GIST AMFT, MA

MEDICARE: KIRSTEN NOEL GIST AMFT, MA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1609351816
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIRSTEN NOEL GIST AMFT, MA
Provider Business Mailing Address
First Line : 415 S CHATHAM CIR APT C
Second Line :
City : ANAHEIM
State : CA
Zip : 92806-4366
Country : US
Telephone Number : 951-318-1106
Fax Number :
Provider Business Practice Location Address
First Line : 505 S VILLA REAL STE 117
Second Line :
City : ANAHEIM
State : CA
Zip : 92807-3441
Country : US
Telephone Number : 657-236-4411
Fax Number : 657-236-4747
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2018
Last Update Date : 10/03/2018

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