Healthcare Provider Details

I. General information

NPI: 1669159075
Provider Name (Legal Business Name): KENDRA RENEE GODFREY LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 WILSHIRE BLVD # 129
SANTA MONICA CA
90403-5406
US

IV. Provider business mailing address

1223 WILSHIRE BLVD # 129
SANTA MONICA CA
90403-5406
US

V. Phone/Fax

Practice location:
  • Phone: 310-220-4021
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number155409
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: