Provider Demographics
NPI:1518479120
Name:LEITNER, KIRSTEN (LMFT)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:LEITNER
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Practice Address - Street 1:2011 P ST STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95811-5225
Practice Address - Country:US
Practice Address - Phone:916-281-9090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-04
Last Update Date:2021-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist