Provider Demographics
NPI:1235546243
Name:KAYNE, ANASTACIA (LMFT)
Entity Type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:
Last Name:KAYNE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:KAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11731 TELEGRAPH RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670-3675
Mailing Address - Country:US
Mailing Address - Phone:562-942-8256
Mailing Address - Fax:
Practice Address - Street 1:11731 TELEGRAPH RD
Practice Address - Street 2:SUITE G
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-3675
Practice Address - Country:US
Practice Address - Phone:562-942-8256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF76907101YM0800X
CA102777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health