Provider Demographics
NPI:1710127964
Name:PACIFIC COMPOSURE PSYCHIATRY & HYPNOTHERAPY
Entity Type:Organization
Organization Name:PACIFIC COMPOSURE PSYCHIATRY & HYPNOTHERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT, DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-334-0530
Mailing Address - Street 1:7960B SOQUEL DR # 419
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-3916
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 7TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-4732
Practice Address - Country:US
Practice Address - Phone:831-334-0530
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-28
Last Update Date:2009-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0675022084P0800X, 2084P0802X, 2084S0012X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty