Provider Demographics
NPI:1932637105
Name:DECHELLIS, KIMBERLY AHLUWALIA (LMFT)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:AHLUWALIA
Last Name:DECHELLIS
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 1:19051 GOLDENWEST ST STE 106-439
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-2155
Mailing Address - Country:US
Mailing Address - Phone:408-802-8007
Mailing Address - Fax:
Practice Address - Street 1:19742 MACARTHUR BLVD STE 100
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2408
Practice Address - Country:US
Practice Address - Phone:714-646-8034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99321106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist