Provider Demographics
NPI:1740830389
Name:KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC
Entity type:Organization
Organization Name:KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOY
Authorized Official - Middle Name:LYN
Authorized Official - Last Name:KENDALL
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:707-535-6615
Mailing Address - Street 1:1622 4TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4020
Mailing Address - Country:US
Mailing Address - Phone:707-535-6615
Mailing Address - Fax:
Practice Address - Street 1:1622 4TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4020
Practice Address - Country:US
Practice Address - Phone:707-571-1714
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty