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General NPI Number Information
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NPI Number | 1275333619
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Entity Type | Individual
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Provider Name | KELLEY MARIE CANTOS AMFT
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Gender | Female
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Dates
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Enumeration Date | 03/14/2025
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Last Update Date | 03/14/2025
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Provider Practice Location Address
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Address Line | 41669 WINCHESTER RD STE 101
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City | TEMECULA
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State | CA
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Zip | 92590-4872
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Country | US
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Telephone | 951-394-3772
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Fax |
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Provider Business Mailing Address
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Address Line | 31945 CORTEZ CIR
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City | MURRIETA
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State | CA
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Zip | 92563-6296
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Country | US
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Telephone | 760-214-8802
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 153873
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License Number State | CA
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