Provider Demographics
NPI:1619225554
Name:KAPPADAKUNNEL, BRYANA ROCHELLE (LMFT, IFECMHS)
Entity Type:Individual
Prefix:MRS
First Name:BRYANA
Middle Name:ROCHELLE
Last Name:KAPPADAKUNNEL
Suffix:
Gender:F
Credentials:LMFT, IFECMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 S CATALINA AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5513
Mailing Address - Country:US
Mailing Address - Phone:424-216-9600
Mailing Address - Fax:
Practice Address - Street 1:1801 S CATALINA AVE STE 306
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5513
Practice Address - Country:US
Practice Address - Phone:424-216-9600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-27
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF75926106H00000X
CALMFT90464106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist