Provider Demographics
NPI:1255806923
Name:ARYAL, KIRAN
Entity type:Individual
Prefix:
First Name:KIRAN
Middle Name:
Last Name:ARYAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 MCCALLUM BLVD APT 1716
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252-6179
Mailing Address - Country:US
Mailing Address - Phone:318-791-6167
Mailing Address - Fax:
Practice Address - Street 1:210 E SANTA FE AVE
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2443
Practice Address - Country:US
Practice Address - Phone:318-791-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-09
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-CTL0199051106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist