Provider Demographics
NPI:1104466473
Name:YACKLEY, KIRSTEN NOELLE (LMFT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:NOELLE
Last Name:YACKLEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1023 HARCOURT AVE
Mailing Address - Street 2:
Mailing Address - City:SEASIDE
Mailing Address - State:CA
Mailing Address - Zip Code:93955-5305
Mailing Address - Country:US
Mailing Address - Phone:949-212-0741
Mailing Address - Fax:
Practice Address - Street 1:1023 HARCOURT AVE
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:CA
Practice Address - Zip Code:93955-5305
Practice Address - Country:US
Practice Address - Phone:949-212-0741
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-14
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist