Provider Demographics
NPI:1245863273
Name:STAMPER, KENNETH CARL (LMFT)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:CARL
Last Name:STAMPER
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 SAN CARLOS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-4739
Mailing Address - Country:US
Mailing Address - Phone:321-525-0725
Mailing Address - Fax:
Practice Address - Street 1:2211 POST ST STE 300
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3464
Practice Address - Country:US
Practice Address - Phone:321-525-0725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-18
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114139106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist