Provider Demographics
NPI:1225243843
Name:KAYSING, JON (LMFT)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:
Last Name:KAYSING
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461718
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90046-9718
Mailing Address - Country:US
Mailing Address - Phone:310-574-2813
Mailing Address - Fax:
Practice Address - Street 1:400 CORPORATE POINTE STE A4000
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-7615
Practice Address - Country:US
Practice Address - Phone:310-574-2813
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7283Medicaid