Healthcare Provider Details

I. General information

NPI: 1871324046
Provider Name (Legal Business Name): PARENTS ANONYMOUS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38345 EAST 30TH STREET SUITE C-2
PALMDALE CA
93550
US

IV. Provider business mailing address

435 YALE AVENUE
CLAREMONT CA
91711-4340
US

V. Phone/Fax

Practice location:
  • Phone: 661-418-2871
  • Fax:
Mailing address:
  • Phone: 909-575-4211
  • 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: MISS KELLY RYAN KOZLOWSKI
Title or Position: SENIOR DIRECTOR OF MENTAL HEALTH SE
Credential: LMFT 162098
Phone: 661-418-2871