Healthcare Provider Details

I. General information

NPI: 1235546243
Provider Name (Legal Business Name): ANASTACIA KAYNE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STACY KAYNE

II. Dates (important events)

Enumeration Date: 07/22/2014
Last Update Date: 11/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11731 TELEGRAPH RD SUITE G
SANTA FE SPRINGS CA
90670-3675
US

IV. Provider business mailing address

11731 TELEGRAPH RD SUITE G
SANTA FE SPRINGS CA
90670-3675
US

V. Phone/Fax

Practice location:
  • Phone: 562-942-8256
  • Fax:
Mailing address:
  • Phone: 562-942-8256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF76907
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102777
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: