Healthcare Provider Details

I. General information

NPI: 1558296509
Provider Name (Legal Business Name): KALEN MARSHALL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 N ALTADENA DR STE 401
PASADENA CA
91107-7330
US

IV. Provider business mailing address

133 N ALTADENA DR STE 401
PASADENA CA
91107-7330
US

V. Phone/Fax

Practice location:
  • Phone: 626-921-0113
  • Fax: 626-921-0214
Mailing address:
  • Phone: 626-921-0113
  • Fax: 626-921-0214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: