Provider Demographics
NPI:1972892560
Name:MCNEELY, KRISTEN (LMFT, BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:LMFT, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:459 WILLOW GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-8225
Mailing Address - Country:US
Mailing Address - Phone:805-297-3244
Mailing Address - Fax:
Practice Address - Street 1:459 WILLOW GLEN CIR
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-8225
Practice Address - Country:US
Practice Address - Phone:805-297-3244
Practice Address - Fax:805-456-1627
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-10-6761103K00000X
CALMFT84291106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst