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General NPI Number Information
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NPI Number | 1164057451
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Entity Type | Organization
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Legal Business Name | KALBERG MARRIAGE AND FAMILY COUNSELING PC
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Dates
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Enumeration Date | 03/06/2020
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Last Update Date | 03/06/2020
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Provider Practice Location Address
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Address Line | 7740 W MANCHESTER AVE STE 109
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-8449
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Country | US
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Telephone | 310-592-4980
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Fax |
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Provider Business Mailing Address
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Address Line | 8687 FALMOUTH AVE UNIT 103
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City | PLAYA DEL REY
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State | CA
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Zip | 90293-8797
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Country | US
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Telephone | 310-592-4980
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | SHANNON MARIE KALBERG
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Credential | LMFT
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Telephone | 310-592-4980
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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 |
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License Number State |
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