Provider Demographics
NPI:1598336018
Name:WOLFF, KYLIE MARIE (AMFT)
Entity Type:Individual
Prefix:
First Name:KYLIE
Middle Name:MARIE
Last Name:WOLFF
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 MONMOUTH DR
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-3801
Mailing Address - Country:US
Mailing Address - Phone:805-755-8211
Mailing Address - Fax:
Practice Address - Street 1:2021 SPERRY AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-7408
Practice Address - Country:US
Practice Address - Phone:805-669-8846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119886106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist