Healthcare Provider Details

I. General information

NPI: 1720994866
Provider Name (Legal Business Name): ASHLYN KENLY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12781 JOSEPHINE ST
GARDEN GROVE CA
92841-4622
US

IV. Provider business mailing address

3 W YALE LOOP
IRVINE CA
92604-3618
US

V. Phone/Fax

Practice location:
  • Phone: 657-251-0503
  • Fax:
Mailing address:
  • Phone: 949-942-9306
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberRT1444840526
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: