Provider Demographics
NPI:1992131577
Name:KIVA SPIRIT FOUNDATION
Entity type:Organization
Organization Name:KIVA SPIRIT FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMES
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LMFT
Authorized Official - Phone:925-485-9370
Mailing Address - Street 1:PO BOX 1424
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-0142
Mailing Address - Country:US
Mailing Address - Phone:925-485-9370
Mailing Address - Fax:
Practice Address - Street 1:2222 2ND ST
Practice Address - Street 2:SUITE 12
Practice Address - City:LIVERMORE
Practice Address - State:CA
Practice Address - Zip Code:94550-4554
Practice Address - Country:US
Practice Address - Phone:925-485-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare