Provider Demographics
NPI:1174671341
Name:PAGE, KIRSTEN ANNETTE MUELLER (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:KIRSTEN
Middle Name:ANNETTE MUELLER
Last Name:PAGE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:KIRSTEN
Other - Middle Name:ANNETTE
Other - Last Name:MUELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:1515 N SAN FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-1435
Mailing Address - Country:US
Mailing Address - Phone:928-213-0344
Mailing Address - Fax:928-774-2801
Practice Address - Street 1:1515 N SAN FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-1435
Practice Address - Country:US
Practice Address - Phone:928-213-0344
Practice Address - Fax:928-774-2801
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT - 10040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist