Provider Demographics
NPI:1982620613
Name:KIEL, SHARON ELAINE (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ELAINE
Last Name:KIEL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:ELAINE
Other - Last Name:VAN DE HOUTEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:PO BOX 5132
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-7132
Mailing Address - Country:US
Mailing Address - Phone:714-876-5879
Mailing Address - Fax:909-860-1960
Practice Address - Street 1:1370 BREA BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-4125
Practice Address - Country:US
Practice Address - Phone:714-876-5879
Practice Address - Fax:909-860-1960
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34211106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist