Provider Demographics
NPI:1184432114
Name:MCCALL, KINDRA LAUREL (LMFT)
Entity type:Individual
Prefix:
First Name:KINDRA
Middle Name:LAUREL
Last Name:MCCALL
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 1:180 S LEXINGTON DR APT 1024
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-7016
Mailing Address - Country:US
Mailing Address - Phone:707-483-2102
Mailing Address - Fax:
Practice Address - Street 1:4088 BRIDGE ST STE 8
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-7144
Practice Address - Country:US
Practice Address - Phone:916-474-9325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-23
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152115106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist