Healthcare Provider Details

I. General information

NPI: 1194665729
Provider Name (Legal Business Name): KAERA ELAN SPENCER-PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3695 ALAMO ST
SIMI VALLEY CA
93063-2188
US

IV. Provider business mailing address

3695 ALAMO ST
SIMI VALLEY CA
93063-2188
US

V. Phone/Fax

Practice location:
  • Phone: 805-842-1994
  • Fax:
Mailing address:
  • Phone: 805-842-1994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT161447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: