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General NPI Number Information
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NPI Number | 1043759491
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Entity Type | Organization
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Legal Business Name | KEMP INDIVIDUAL & FAMILY THERAPY, INC.
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Dates
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Enumeration Date | 02/17/2017
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Last Update Date | 02/06/2025
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Provider Practice Location Address
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Address Line | 20786 BEAR VALLEY RD STE I
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City | APPLE VALLEY
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State | CA
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Zip | 92308-6909
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Country | US
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Telephone | 619-742-9479
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Fax | 760-254-9904
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Provider Business Mailing Address
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Address Line | 9979 MOCKINGBIRD AVE
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City | APPLE VALLEY
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State | CA
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Zip | 92308-8302
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Country | US
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Telephone | 619-742-9479
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Fax | 760-254-9904
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Authorized Official
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Title or Position | OWNER/VICE PRESIDENT
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Name | MRS. MARY SHANNON KEMP
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Credential | LMFT
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Telephone | 619-742-9479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | LMFT 51919
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License Number State | CA
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