Healthcare Provider Details

I. General information

NPI: 1659611234
Provider Name (Legal Business Name): JAVON KEMP SR. MH COUNSELOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 12/12/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2151 COLLEGE AVE
BAKERSFIELD CA
93305-4113
US

IV. Provider business mailing address

PO BOX 1000
BAKERSFIELD CA
93302-1000
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-8080
  • Fax:
Mailing address:
  • Phone: 661-776-0058
  • Fax: 661-836-8834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC-12829
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: