Provider Demographics
NPI:1073363131
Name:KIRKLAND, NATALIE M (CBT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:M
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:CBT
Other - Prefix:
Other - First Name:NAT
Other - Middle Name:
Other - Last Name:KIRKLAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CBT
Mailing Address - Street 1:3129 OLD FAIRHAVEN PKWY UNIT 314
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-2051
Mailing Address - Country:US
Mailing Address - Phone:206-605-9507
Mailing Address - Fax:
Practice Address - Street 1:4201 MERIDIAN ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-5532
Practice Address - Country:US
Practice Address - Phone:360-305-3275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-22
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61482523106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician