Provider Demographics
NPI:1518573633
Name:KIRK, KEEAN ANDREW (MA, AMFT)
Entity Type:Individual
Prefix:MR
First Name:KEEAN
Middle Name:ANDREW
Last Name:KIRK
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:MR
Other - First Name:KEEAN
Other - Middle Name:ANDREW
Other - Last Name:MENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, AMFT
Mailing Address - Street 1:26035 MOULTON PKWY APT 138
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-6246
Mailing Address - Country:US
Mailing Address - Phone:949-324-2622
Mailing Address - Fax:949-452-0889
Practice Address - Street 1:23461 S POINTE DR STE 100
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1523
Practice Address - Country:US
Practice Address - Phone:949-452-0888
Practice Address - Fax:949-452-0889
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT108680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty