Provider Demographics
NPI:1487356713
Name:MYRVOLD, KASARA EILEEN (RADT)
Entity type:Individual
Prefix:
First Name:KASARA
Middle Name:EILEEN
Last Name:MYRVOLD
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31477 SUNSET AVE
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-8956
Mailing Address - Country:US
Mailing Address - Phone:951-663-5690
Mailing Address - Fax:
Practice Address - Street 1:23931 WARREN RD
Practice Address - Street 2:
Practice Address - City:SAN JACINTO
Practice Address - State:CA
Practice Address - Zip Code:92582-3795
Practice Address - Country:US
Practice Address - Phone:951-663-5690
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-20
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)