Healthcare Provider Details

I. General information

NPI: 1689272544
Provider Name (Legal Business Name): KALEIDOSCOPE SOLUTIONS FAMILY THERAPY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25876 THE OLD ROAD #85
STEVENSON RANCH CA
91381
US

IV. Provider business mailing address

25876 THE OLD ROAD #85
STEVENSON RANCH CA
91381
US

V. Phone/Fax

Practice location:
  • Phone: 818-647-2988
  • Fax: 818-791-2377
Mailing address:
  • Phone: 818-647-2988
  • Fax: 818-791-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name: CARLA FRANCO
Title or Position: EXECUTIVE DIRECTOR
Credential: LMFT
Phone: 818-647-2988