Healthcare Provider Details

I. General information

NPI: 1154178127
Provider Name (Legal Business Name): KIDS UNFILTERED, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2024
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S PACIFIC COAST HWY
REDONDO BEACH CA
90277-4903
US

IV. Provider business mailing address

PO BOX 19
PORTOLA CA
96122-0019
US

V. Phone/Fax

Practice location:
  • Phone: 858-353-0665
  • Fax:
Mailing address:
  • Phone: 530-316-4248
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE CUNNINGHAM
Title or Position: OWNER
Credential: LCSW
Phone: 858-353-0665