Provider Demographics
NPI:1841925104
Name:CUENE, KILEY
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:
Last Name:CUENE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4101 BIRCH ST STE 230E
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2238
Mailing Address - Country:US
Mailing Address - Phone:414-712-8194
Mailing Address - Fax:
Practice Address - Street 1:4101 BIRCH ST STE 230E
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2238
Practice Address - Country:US
Practice Address - Phone:949-873-4617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-20
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool