Provider Demographics
NPI:1174265045
Name:KIRK, CALLIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CALLIE
Middle Name:
Last Name:KIRK
Suffix:
Gender:F
Credentials:LMFT
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 631
Mailing Address - Street 2:
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92871-0631
Mailing Address - Country:US
Mailing Address - Phone:714-388-6187
Mailing Address - Fax:
Practice Address - Street 1:2900 E LINCOLN AVE APT 212
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92806-4069
Practice Address - Country:US
Practice Address - Phone:714-388-8578
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA116694106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist