Provider Demographics
NPI:1740656735
Name:SCRIBNER, KELLY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SCRIBNER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:KELLY
Other - Middle Name:
Other - Last Name:SCRIBNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:8350 ARCHIBALD AVE
Mailing Address - Street 2:100
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-3669
Mailing Address - Country:US
Mailing Address - Phone:909-987-8400
Mailing Address - Fax:
Practice Address - Street 1:8350 ARCHIBALD AVE
Practice Address - Street 2:100
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-3669
Practice Address - Country:US
Practice Address - Phone:909-987-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT96409106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist