Provider Demographics
NPI:1598535940
Name:ANDERSON, KYLEE (LMFT)
Entity Type:Individual
Prefix:
First Name:KYLEE
Middle Name:
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KY
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5919 W 3RD ST STE 1E
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-2833
Mailing Address - Country:US
Mailing Address - Phone:310-845-6167
Mailing Address - Fax:
Practice Address - Street 1:5919 W 3RD ST STE 1E
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-2833
Practice Address - Country:US
Practice Address - Phone:310-845-6167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA141713106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist