Provider Demographics
NPI:1770153801
Name:KIRCHHOFF, MARLIS CORNELIA (PHD)
Entity type:Individual
Prefix:DR
First Name:MARLIS
Middle Name:CORNELIA
Last Name:KIRCHHOFF
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 644820 WASHINGTON STATE UNIV
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164-4820
Mailing Address - Country:US
Mailing Address - Phone:509-335-3935
Mailing Address - Fax:509-335-1030
Practice Address - Street 1:305 TROY MALL LANE WASHINGTON STATE UNIV
Practice Address - Street 2:
Practice Address - City:PULLMAN
Practice Address - State:WA
Practice Address - Zip Code:99164-0001
Practice Address - Country:US
Practice Address - Phone:509-335-3935
Practice Address - Fax:509-335-1030
Is Sole Proprietor?:No
Enumeration Date:2021-06-30
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPSY-203377103TC0700X
WAPY60677390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical