Healthcare Provider Details

I. General information

NPI: 1144167891
Provider Name (Legal Business Name): KJM FAMILY THERAPY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2026
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

424 N SHATTUCK PL
ORANGE CA
92866-1233
US

IV. Provider business mailing address

960 N TUSTIN ST
ORANGE CA
92867-5956
US

V. Phone/Fax

Practice location:
  • Phone: 714-882-0754
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: KERRY MARTINELLI
Title or Position: CEO
Credential: LMFT
Phone: 714-882-0754