Provider Demographics
NPI:1073833216
Name:KAKIUCHI, KRISTIN (MS ,MFT)
Entity Type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:
Last Name:KAKIUCHI
Suffix:
Gender:F
Credentials:MS ,MFT
Other - Prefix:MRS
Other - First Name:KRISTIN
Other - Middle Name:
Other - Last Name:RUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, MFT
Mailing Address - Street 1:9418 W LAKE MEAD BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-8312
Mailing Address - Country:US
Mailing Address - Phone:702-807-3082
Mailing Address - Fax:702-445-6454
Practice Address - Street 1:9418 W LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89134-8312
Practice Address - Country:US
Practice Address - Phone:702-807-3082
Practice Address - Fax:702-445-6454
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-10
Last Update Date:2014-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV01184106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist