Basic Information
| Provider Information | |||||||||
| NPI: | 1609141647 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | RICHTER | ||||||||
| FirstName: | KIRSTEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257000 | ||||||||
| FaxNumber: | 9099451031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3102 E. HIGHLAND AVENUE | ||||||||
| Address2: | MEDICAL STAFF OFFICE | ||||||||
| City: | PATTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094257000 | ||||||||
| FaxNumber: | 9099451031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2012 | ||||||||
| LastUpdateDate: | 11/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LCS25407 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 25407 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.