Healthcare Provider Details

I. General information

NPI: 1730083916
Provider Name (Legal Business Name): CARLY L KIEL AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12626 RIVERSIDE DR STE 409
VALLEY VILLAGE CA
91607-3451
US

IV. Provider business mailing address

1601 LYMAN PL APT 2
LOS ANGELES CA
90027-5409
US

V. Phone/Fax

Practice location:
  • Phone: 424-785-9495
  • Fax:
Mailing address:
  • Phone: 901-355-1455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number165179
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: