Provider Demographics
NPI:1659543189
Name:BLAND, KASEY DJUANA
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:DJUANA
Last Name:BLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:649 E ALBERTONI ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90746-1538
Mailing Address - Country:US
Mailing Address - Phone:310-436-9300
Mailing Address - Fax:
Practice Address - Street 1:649 E ALBERTONI ST STE 100
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90746-1538
Practice Address - Country:US
Practice Address - Phone:310-436-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-25
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT108088106H00000X
172V00000X
CAAMFT149570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No172V00000XOther Service ProvidersCommunity Health Worker