Healthcare Provider Details

I. General information

NPI: 1962149070
Provider Name (Legal Business Name): KYLAH JAY PINCH APCC, AMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KYLE JEFFREY PINCH

II. Dates (important events)

Enumeration Date: 05/19/2022
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 COTTONWOOD ST STE 14
WOODLAND CA
95695-3603
US

IV. Provider business mailing address

520 COTTONWOOD ST STE 14
WOODLAND CA
95695-3603
US

V. Phone/Fax

Practice location:
  • Phone: 530-656-5080
  • Fax: 530-666-7682
Mailing address:
  • Phone: 530-656-5080
  • Fax: 530-666-7682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16958
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number148646
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 6
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: