Provider Demographics
NPI:1891146817
Name:BOBO, KIANA
Entity Type:Individual
Prefix:
First Name:KIANA
Middle Name:
Last Name:BOBO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KIANA
Other - Middle Name:
Other - Last Name:BOBO-HATLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5849 CROCKER ST UNIT L
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90003-1311
Mailing Address - Country:US
Mailing Address - Phone:323-234-4445
Mailing Address - Fax:323-234-4477
Practice Address - Street 1:5849 CROCKER ST UNIT L
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90003-1311
Practice Address - Country:US
Practice Address - Phone:323-234-4445
Practice Address - Fax:323-234-4477
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121493.106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist