Provider Demographics
NPI:1710741772
Name:TOWNSEND, KYANDICE
Entity Type:Individual
Prefix:
First Name:KYANDICE
Middle Name:
Last Name:TOWNSEND
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 1:27120 EUCALYPTUS AVE # G205
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4543
Mailing Address - Country:US
Mailing Address - Phone:310-740-3821
Mailing Address - Fax:
Practice Address - Street 1:27120 EUCALYPTUS AVE # G205
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4543
Practice Address - Country:US
Practice Address - Phone:310-740-3821
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician