MEDICARE: MRS. KIRSTIE ARVIZU LPCC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	10089	CA
2	101YM0800X	Mental Health Counselor	6086
3	101YP2500X	Professional Counselor	10089	CA
4	101YP2500X	Professional Counselor	6086	CA
5	101YM0800X	Mental Health Counselor	10089	CA

General Provider Information

NPI Number	:	1972185718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIRSTIE ARVIZU LPCC

Provider Business Mailing Address
First Line	:	11087 ROXBORO RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3657
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5752 OBERLIN DR STE 222
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-1747
Country	:	US
Telephone Number	:	858-466-7328
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	12/16/2021

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