MEDICARE: PURPLE PATH FAMILY THERAPY AND COUNSELING CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1043155781
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURPLE PATH FAMILY THERAPY AND COUNSELING CENTER INC

Provider Business Mailing Address
First Line	:	2400 N TENAYA WAY STE 130
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-0645
Country	:	US
Telephone Number	:	702-329-8942
Fax Number	:	702-447-7811

Provider Business Practice Location Address
First Line	:	1543 E PALMDALE BLVD STE K2
Second Line	:
City	:	PALMDALE
State	:	CA
Zip	:	93550-2000
Country	:	US
Telephone Number	:	702-328-8942
Fax Number	:	702-447-7811

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. STEPHANIE MARIE KINNEY
Credential	:	LMFT
Telephone Number	:	702-291-8371

Provider Enumeration Date	:	04/20/2026
Last Update Date	:	04/20/2026

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