Provider Demographics
NPI:1194472654
Name:TACHIKI, KRISTEN K (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:K
Last Name:TACHIKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15014 DENLEY ST
Mailing Address - Street 2:
Mailing Address - City:HACIENDA HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91745-2010
Mailing Address - Country:US
Mailing Address - Phone:626-384-9756
Mailing Address - Fax:
Practice Address - Street 1:15014 DENLEY ST
Practice Address - Street 2:
Practice Address - City:HACIENDA HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91745-2010
Practice Address - Country:US
Practice Address - Phone:626-384-9756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99264101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
LCSW99264OtherBBS