Provider Demographics
NPI:1235276080
Name:KIRK, KATHERINE ANN (MFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ANN
Last Name:KIRK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 N BERETANIA STREET
Mailing Address - Street 2:2402
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-4760
Mailing Address - Country:US
Mailing Address - Phone:808-215-9174
Mailing Address - Fax:707-313-9521
Practice Address - Street 1:60 N BERETANIA STREET
Practice Address - Street 2:2402
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-4760
Practice Address - Country:US
Practice Address - Phone:808-215-9174
Practice Address - Fax:808-465-3261
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC297101YP2500X
CAMFC46475106H00000X
HIMFT396106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional