Healthcare Provider Details

I. General information

NPI: 1336017995
Provider Name (Legal Business Name): KIBO PSYCHIATRY AND WELLNESS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2025
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2829 TOWNSGATE RD STE 100
WESTLAKE VILLAGE CA
91361-3015
US

IV. Provider business mailing address

2829 TOWNSGATE RD STE 100
WESTLAKE VILLAGE CA
91361-3015
US

V. Phone/Fax

Practice location:
  • Phone: 805-229-1525
  • Fax: 818-337-1730
Mailing address:
  • Phone: 805-229-1525
  • Fax: 818-337-1730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY COVINGTON
Title or Position: CO-OWNER
Credential: MD
Phone: 805-229-1525