Provider Demographics
NPI:1093009334
Name:MUIR, KATHLEEN GRACE (MFTI)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:GRACE
Last Name:MUIR
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 881654
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92168-1654
Mailing Address - Country:US
Mailing Address - Phone:619-873-7738
Mailing Address - Fax:619-324-4154
Practice Address - Street 1:2710 ALPINE BLVD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-2276
Practice Address - Country:US
Practice Address - Phone:619-873-7738
Practice Address - Fax:619-324-4154
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52081106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist