Provider Demographics
NPI:1891195525
Name:KENDALL, JOY (MFT)
Entity Type:Individual
Prefix:
First Name:JOY
Middle Name:
Last Name:KENDALL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5213 EL MERCADO PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1301
Mailing Address - Country:US
Mailing Address - Phone:707-571-1714
Mailing Address - Fax:
Practice Address - Street 1:5213 EL MERCADO PKWY
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1301
Practice Address - Country:US
Practice Address - Phone:707-571-1714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-29
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 48912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist