Healthcare Provider Details

I. General information

NPI: 1528770377
Provider Name (Legal Business Name): KYLE WINDHAM LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 04/11/2026
Certification Date: 04/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 DIVISADERO ST PMB # 212
SAN FRANCISCO CA
94117-2213
US

IV. Provider business mailing address

1747 MCALLISTER ST APT 3
SAN FRANCISCO CA
94115-4346
US

V. Phone/Fax

Practice location:
  • Phone: 925-492-7319
  • Fax:
Mailing address:
  • Phone: 925-492-7319
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT161789
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: