Provider Demographics
NPI:1578787388
Name:MEADOWS, KIRSTEN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:
Last Name:MEADOWS
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:PO BOX 2593
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-5593
Mailing Address - Country:US
Mailing Address - Phone:510-287-8900
Mailing Address - Fax:
Practice Address - Street 1:1035 SAN PABLO AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2275
Practice Address - Country:US
Practice Address - Phone:510-287-8900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40945106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA321154OtherMHN PIN
CA275323OtherCOMPSYCH PROVIDER #
CA9442714OtherPHCS PID#