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General NPI Number Information
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NPI Number | 1932637105
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Entity Type | Individual
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Provider Name | KIMBERLY AHLUWALIA DECHELLIS LMFT
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Gender | Female
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Dates
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Enumeration Date | 05/31/2017
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 19742 MACARTHUR BLVD STE 100
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City | IRVINE
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State | CA
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Zip | 92612-2408
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Country | US
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Telephone | 714-646-8034
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Fax |
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Provider Business Mailing Address
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Address Line | 19051 GOLDENWEST ST STE 106-439
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-2155
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Country | US
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Telephone | 408-802-8007
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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 | 99321
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License Number State | CA
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