Provider Demographics
NPI:1265904387
Name:MAUS, KIRBY (LMFT)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:
Last Name:MAUS
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2388 S BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264-5906
Mailing Address - Country:US
Mailing Address - Phone:760-534-1063
Mailing Address - Fax:
Practice Address - Street 1:2388 S BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92264-5906
Practice Address - Country:US
Practice Address - Phone:760-534-1063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-31
Last Update Date:2023-08-08
Deactivation Date:2019-02-14
Deactivation Code:
Reactivation Date:2021-05-25
Provider Licenses
StateLicense IDTaxonomies
CA86480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist