Provider Demographics
NPI:1265099527
Name:KUIT, KELLEY (LMFT)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:
Last Name:KUIT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12625 FREDERICK ST STE I5
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92553-5235
Mailing Address - Country:US
Mailing Address - Phone:626-321-7796
Mailing Address - Fax:
Practice Address - Street 1:12625 FREDERICK ST
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92553-5216
Practice Address - Country:US
Practice Address - Phone:626-321-7966
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122349106H00000X
390200000X
CA139895106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program