Provider Demographics
NPI:1093226029
Name:VALENCIA, KEVIN MICHAEL ANDREW
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MICHAEL ANDREW
Last Name:VALENCIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2531 W WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-2637
Mailing Address - Country:US
Mailing Address - Phone:714-226-9888
Mailing Address - Fax:714-226-9887
Practice Address - Street 1:2531 W WOODLAND DR
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2637
Practice Address - Country:US
Practice Address - Phone:714-226-9888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA117264106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist