Provider Demographics
NPI:1750446803
Name:KIRK, SUZANNE EILEEN (MFT)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:EILEEN
Last Name:KIRK
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 1:25350 MAGIC MOUNTAIN PARKWAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-714-8110
Mailing Address - Fax:701-364-9820
Practice Address - Street 1:25350 MAGIC MOUNTAIN PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355
Practice Address - Country:US
Practice Address - Phone:661-714-8110
Practice Address - Fax:701-364-9820
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-27
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND449-8-1-00-156101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health