Provider Demographics
NPI:1396514352
Name:SCHMITZ, KJERSTI C (MPH, EDM)
Entity type:Individual
Prefix:
First Name:KJERSTI
Middle Name:C
Last Name:SCHMITZ
Suffix:
Gender:F
Credentials:MPH, EDM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17476
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92623-7476
Mailing Address - Country:US
Mailing Address - Phone:191-744-3036
Mailing Address - Fax:
Practice Address - Street 1:145 W YALE LOOP
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-3620
Practice Address - Country:US
Practice Address - Phone:917-443-0368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007534101YM0800X
CA10985101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health