Provider Demographics
NPI:1922588862
Name:KALLIN, DANIELLE WAGNER (LMFT)
Entity Type:Individual
Prefix:
First Name:DANIELLE
Middle Name:WAGNER
Last Name:KALLIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28724 STARTREE LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91390-4140
Mailing Address - Country:US
Mailing Address - Phone:801-550-0693
Mailing Address - Fax:
Practice Address - Street 1:21380 CENTRE POINTE PKWY
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3050
Practice Address - Country:US
Practice Address - Phone:661-259-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-20
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98048106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist