Provider Demographics
NPI:1376164566
Name:KIRSTEN LEITNER, LICENSED MARRIAGE & FAMILY THERAPIST, A PROF. CORP.
Entity Type:Organization
Organization Name:KIRSTEN LEITNER, LICENSED MARRIAGE & FAMILY THERAPIST, A PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:510-913-3166
Mailing Address - Street 1:627 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-2113
Mailing Address - Country:US
Mailing Address - Phone:510-913-3166
Mailing Address - Fax:916-970-0041
Practice Address - Street 1:2830 I ST STE 306
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:916-281-9090
Practice Address - Fax:916-970-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty