Provider Demographics
NPI:1801555222
Name:CRAVEN, KIERSTEN ALEANA
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:ALEANA
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIERSTEN
Other - Middle Name:ALEANA
Other - Last Name:JUSTICE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19 SANDPIPER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-2616
Mailing Address - Country:US
Mailing Address - Phone:336-382-6580
Mailing Address - Fax:
Practice Address - Street 1:9844 RESEARCH DR STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4381
Practice Address - Country:US
Practice Address - Phone:760-815-9056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty