Provider Demographics
NPI:1710634126
Name:KIREEVA, OXANA (LMFT, APCC)
Entity Type:Individual
Prefix:
First Name:OXANA
Middle Name:
Last Name:KIREEVA
Suffix:
Gender:F
Credentials:LMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26325 W GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-6571
Mailing Address - Country:US
Mailing Address - Phone:949-742-2373
Mailing Address - Fax:
Practice Address - Street 1:26325 W GROVE CIR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6571
Practice Address - Country:US
Practice Address - Phone:949-742-2373
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-05
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142867106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health