Provider Demographics
NPI:1770705493
Name:YOUNG, KIRSTEN S (LMFT)
Entity type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:S
Last Name:YOUNG
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:PO BOX 299
Mailing Address - Street 2:
Mailing Address - City:NEVADA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95959-0299
Mailing Address - Country:US
Mailing Address - Phone:530-559-7982
Mailing Address - Fax:530-265-4964
Practice Address - Street 1:220 MAIN ST STE 5C
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-2527
Practice Address - Country:US
Practice Address - Phone:530-559-7982
Practice Address - Fax:530-265-4964
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT42832106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist