Healthcare Provider Details

I. General information

NPI: 1831037084
Provider Name (Legal Business Name): KENYAI O'NEAL AMFT
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2026
Last Update Date: 03/21/2026
Certification Date: 03/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6203 SAN IGNACIO AVE STE 100
SAN JOSE CA
95119-1358
US

IV. Provider business mailing address

2717 S ROBERTSON BLVD
LOS ANGELES CA
90034-2442
US

V. Phone/Fax

Practice location:
  • Phone: 800-887-0316
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number152748
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: