| Kemp Individual & Family Therapy, Inc. | |
|
14075 Hesperia Road Suite 101 Victorville CA 92395 | |
| (760) 810-0000 | |
| (760) 810-0178 |
| Full Name | Kemp Individual & Family Therapy, Inc. |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 14075 Hesperia Road, Victorville, California |
| Authorized Official Name and Position | Mary Shannon Kemp (OWNER/VICE PRESIDENT) |
| Authorized Official Contact | 7608100000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kemp Individual & Family Therapy, Inc. 14075 Hesperia Road Suite 101 Victorville CA 92395 Ph: (760) 810-0000 | Kemp Individual & Family Therapy, Inc. 14075 Hesperia Road Suite 101 Victorville CA 92395 Ph: (760) 810-0000 |
| NPI Number | 1043759491 |
|---|---|
| Provider Enumeration Date | 02/17/2017 |
| Last Update Date | 03/21/2019 |
| Medicare PECOS PAC ID | 2769721893 |
|---|---|
| Medicare Enrollment ID | O20190306003080 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043759491 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | LMFT 51919 (California) | Primary |
| Provider Name | Yuliana A Medina |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1558751891 PECOS PAC ID: 7911239686 Enrollment ID: I20191029003519 |
| Provider Name | Reina M Woods |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1942423215 PECOS PAC ID: 4981036373 Enrollment ID: I20191125000801 |
| Provider Name | Meliza Q Kinney |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1316564594 PECOS PAC ID: 7214348416 Enrollment ID: I20201119000512 |
| Provider Name | Amanda Bertoldo |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1114367687 PECOS PAC ID: 6406264068 Enrollment ID: I20210420001199 |
| Provider Name | Jacqueline D Machado |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245716802 PECOS PAC ID: 8921402876 Enrollment ID: I20210813002533 |
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