Provider Demographics
NPI:1528008638
Name:KEMP, ANITA (PHD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:KEMP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1615 SHASTA ACRES RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT SHASTA
Mailing Address - State:CA
Mailing Address - Zip Code:96067-9604
Mailing Address - Country:US
Mailing Address - Phone:530-244-6131
Mailing Address - Fax:530-244-6131
Practice Address - Street 1:983 MISSION DE ORO DR
Practice Address - Street 2:SUITE B
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3850
Practice Address - Country:US
Practice Address - Phone:530-244-6131
Practice Address - Fax:530-244-6131
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2017-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14770103T00000X, 103TA0700X, 103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL147700Medicare ID - Type Unspecified
CAOPL147701Medicare ID - Type Unspecified