Provider Demographics
NPI:1174685259
Name:KIRKPATRICK, LAURIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 S MAIN ST
Mailing Address - Street 2:MENTAL HEALTH
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5318
Mailing Address - Country:US
Mailing Address - Phone:925-295-4145
Mailing Address - Fax:
Practice Address - Street 1:710 S BROADWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5294
Practice Address - Country:US
Practice Address - Phone:925-295-4145
Practice Address - Fax:925-295-5226
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6328103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical