Provider Demographics
NPI:1013330380
Name:KIRTH, HOLLY NOEL-CHANG (LMFT)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:NOEL-CHANG
Last Name:KIRTH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:NOEL
Other - Last Name:CHANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 FUNSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1119
Mailing Address - Country:US
Mailing Address - Phone:310-650-3703
Mailing Address - Fax:
Practice Address - Street 1:2211 POST ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3442
Practice Address - Country:US
Practice Address - Phone:499-791-7492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-22
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA84467106H00000X
CA64240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist