Provider Demographics
NPI:1669661443
Name:DECK, KIRSTEN LILLI
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:LILLI
Last Name:DECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5400 ORANGE AVE
Mailing Address - Street 2:SUITE #114
Mailing Address - City:CYPRESS
Mailing Address - State:CA
Mailing Address - Zip Code:90630-3757
Mailing Address - Country:US
Mailing Address - Phone:562-607-5238
Mailing Address - Fax:
Practice Address - Street 1:5400 ORANGE AVE
Practice Address - Street 2:SUITE #114
Practice Address - City:CYPRESS
Practice Address - State:CA
Practice Address - Zip Code:90630-3757
Practice Address - Country:US
Practice Address - Phone:562-607-5238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44967106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist