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General NPI Number Information
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NPI Number | 1528845716
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Entity Type | Individual
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Provider Name | CHEYENNE LEE ANNIE KEMP AMFT
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Gender | Female
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Dates
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Enumeration Date | 09/11/2023
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Last Update Date | 07/22/2024
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Provider Practice Location Address
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Address Line | 309 E MOUNTAIN VIEW ST STE 100
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City | BARSTOW
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State | CA
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Zip | 92311-2814
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Country | US
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Telephone | 909-809-6458
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3152
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City | HELENDALE
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State | CA
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Zip | 92342-3152
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Country | US
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Telephone | 801-940-4880
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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 | 132849
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License Number State | CA
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