MEDICARE: KIERAN LEWIS MEAD AMFT

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	156253	CA

General Provider Information

NPI Number	:	1285314864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIERAN LEWIS MEAD AMFT

Provider Business Mailing Address
First Line	:	3941 POPLAR LN
Second Line	:
City	:	CHINO HILLS
State	:	CA
Zip	:	91709-2655
Country	:	US
Telephone Number	:	909-217-9728
Fax Number	:

Provider Business Practice Location Address
First Line	:	4624 ARLINGTON AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2702
Country	:	US
Telephone Number	:	951-394-0165
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2023
Last Update Date	:	10/03/2025

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