Provider Demographics
NPI:1063762797
Name:KIRK, SARAH E (MFT)
Entity type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:KIRK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 E PAGEANTRY ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90808-4233
Mailing Address - Country:US
Mailing Address - Phone:562-243-7050
Mailing Address - Fax:562-243-7050
Practice Address - Street 1:6715 E PAGEANTRY ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-4233
Practice Address - Country:US
Practice Address - Phone:562-243-7050
Practice Address - Fax:562-243-7050
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-10
Last Update Date:2012-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38467106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist