Provider Demographics
NPI:1043759491
Name:KEMP INDIVIDUAL & FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:KEMP INDIVIDUAL & FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:SHANNON
Authorized Official - Last Name:KEMP
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:760-810-0000
Mailing Address - Street 1:14075 HESPERIA ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395
Mailing Address - Country:US
Mailing Address - Phone:760-810-0000
Mailing Address - Fax:760-810-0178
Practice Address - Street 1:14075 HESPERIA ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395
Practice Address - Country:US
Practice Address - Phone:760-810-0000
Practice Address - Fax:760-810-0178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2019-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 51919106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty