Provider Demographics
NPI:1326157330
Name:KIRKBRIDE, BECKY (MFCC)
Entity Type:Individual
Prefix:
First Name:BECKY
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:MFCC
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:LAUGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:2225 BUCHANAN RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4209
Mailing Address - Country:US
Mailing Address - Phone:925-753-1986
Mailing Address - Fax:
Practice Address - Street 1:2225 BUCHANAN RD
Practice Address - Street 2:SUITE H
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-4209
Practice Address - Country:US
Practice Address - Phone:925-753-1986
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFCC2561106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFCC2561Medicare UPIN