Provider Demographics
NPI:1629676986
Name:ALLEN, KIRSTEN FRANTZICH (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:FRANTZICH
Last Name:ALLEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KIRSTEN
Other - Middle Name:
Other - Last Name:FRANTZICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 491274
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-9274
Mailing Address - Country:US
Mailing Address - Phone:310-571-5609
Mailing Address - Fax:
Practice Address - Street 1:179 S. BARRINGTON PLACE
Practice Address - Street 2:SUITE B
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-9274
Practice Address - Country:US
Practice Address - Phone:310-571-5609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-09
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31964103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical