Provider Demographics
NPI:1457029241
Name:KIRKBRIDE, EMILY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:KIRKBRIDE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 QUAIL ST STE 190
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2745
Mailing Address - Country:US
Mailing Address - Phone:949-891-1504
Mailing Address - Fax:
Practice Address - Street 1:1000 QUAIL ST STE 190
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2745
Practice Address - Country:US
Practice Address - Phone:952-200-8487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-06
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist