Provider Demographics
NPI:1467731075
Name:CONNORS, KEVIN J (MS, MFT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:J
Last Name:CONNORS
Suffix:
Gender:M
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5199 E PACIFIC COAST HWY
Mailing Address - Street 2:SUITE 302N
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-3302
Mailing Address - Country:US
Mailing Address - Phone:562-498-4937
Mailing Address - Fax:562-498-4962
Practice Address - Street 1:5199 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE 302N
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-3302
Practice Address - Country:US
Practice Address - Phone:562-498-4937
Practice Address - Fax:562-498-4962
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-12
Last Update Date:2011-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC19968106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist