Provider Demographics
NPI:1093250185
Name:TORRES, KAYLE ANNE (MA)
Entity Type:Individual
Prefix:
First Name:KAYLE
Middle Name:ANNE
Last Name:TORRES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARDING BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-2471
Mailing Address - Country:US
Mailing Address - Phone:916-259-9706
Mailing Address - Fax:
Practice Address - Street 1:1106 WINDFIELD WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9360
Practice Address - Country:US
Practice Address - Phone:916-357-5837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-27
Last Update Date:2023-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA96009106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist