Provider Demographics
NPI:1891828984
Name:LYDERS HORAK, KIRSTEN MEREDITH (LCSW)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:MEREDITH
Last Name:LYDERS HORAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S MAIN ST
Mailing Address - Street 2:SUITE 210-B
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2352
Mailing Address - Country:US
Mailing Address - Phone:831-796-1547
Mailing Address - Fax:831-757-3135
Practice Address - Street 1:1270 NATIVIDAD RD
Practice Address - Street 2:RM 200
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3122
Practice Address - Country:US
Practice Address - Phone:831-755-4510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 20046104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 20046OtherLCSW