Provider Demographics
NPI:1568177574
Name:FALCON, KAYLEE MARIE
Entity Type:Individual
Prefix:MS
First Name:KAYLEE
Middle Name:MARIE
Last Name:FALCON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1837 CRESTMONT CT
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2619
Mailing Address - Country:US
Mailing Address - Phone:818-207-4224
Mailing Address - Fax:
Practice Address - Street 1:5619 N FIGUEROA ST APT 228
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90042-4979
Practice Address - Country:US
Practice Address - Phone:818-922-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107365106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist