Provider Demographics
NPI:1760842405
Name:GYFORD, KRISTIN JEAN (LCSW)
Entity type:Individual
Prefix:
First Name:KRISTIN
Middle Name:JEAN
Last Name:GYFORD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1065 BUCKS LAKE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-9507
Mailing Address - Country:US
Mailing Address - Phone:530-283-2121
Mailing Address - Fax:530-283-7404
Practice Address - Street 1:1065 BUCKS LAKE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9507
Practice Address - Country:US
Practice Address - Phone:530-283-2121
Practice Address - Fax:530-283-7404
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-23
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBBH-LCSW-LIC-558931041C0700X
CA1230871041C0700X
ORL79761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical