Provider Demographics
NPI:1821464298
Name:KUSS, KELLEY MARIE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:KELLEY
Middle Name:MARIE
Last Name:KUSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:KELLEY
Other - Middle Name:MARIE
Other - Last Name:MORRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:11130 TOWN COUNTRY DR.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505
Mailing Address - Country:US
Mailing Address - Phone:909-810-8279
Mailing Address - Fax:909-614-7882
Practice Address - Street 1:300 E. STATE STREET
Practice Address - Street 2:SUITE 208
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373
Practice Address - Country:US
Practice Address - Phone:909-810-8279
Practice Address - Fax:909-614-7882
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-19
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF92924106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist