Healthcare Provider Details

I. General information

NPI: 1346370848
Provider Name (Legal Business Name): KAYLA ANNE KARESH LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 12/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 EXECUTIVE DR STE 225
SAN DIEGO CA
92121-3094
US

IV. Provider business mailing address

4520 EXECUTIVE DR STE 225
SAN DIEGO CA
92121-3094
US

V. Phone/Fax

Practice location:
  • Phone: 858-202-1822
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT48030
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: