MEDICARE: KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1740830389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC

Provider Business Mailing Address
First Line	:	1622 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4020
Country	:	US
Telephone Number	:	707-535-6615
Fax Number	:

Provider Business Practice Location Address
First Line	:	1622 4TH ST
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4020
Country	:	US
Telephone Number	:	707-571-1714
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JOY LYN KENDALL
Credential	:	LMFT
Telephone Number	:	707-535-6615

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	07/23/2024

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