=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114222387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KANDICE NADENE MARSHALL-CUNANAN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/20/2011
-----------------------------------------------------
Last Update Date | 12/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 N PACIFIC COAST HWY
-----------------------------------------------------
City | REDONDO BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90277-2162
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-316-1640
-----------------------------------------------------
Fax | 310-316-4209
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 516 PENNSFIELD PL STE 212
-----------------------------------------------------
City | THOUSAND OAKS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91360-5575
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-558-5451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 94154
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------