Provider Demographics
NPI:1578778221
Name:KEMP, STAN
Entity Type:Individual
Prefix:
First Name:STAN
Middle Name:
Last Name:KEMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14075 HESPERIA RD STE 101
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-4500
Mailing Address - Country:US
Mailing Address - Phone:760-810-0000
Mailing Address - Fax:760-810-0178
Practice Address - Street 1:14075 HESPERIA RD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-4500
Practice Address - Country:US
Practice Address - Phone:760-810-0000
Practice Address - Fax:760-810-0178
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist