Provider Demographics
NPI:1366213787
Name:RILEY, KENDRA R (LPCC, RN)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:R
Last Name:RILEY
Suffix:
Gender:F
Credentials:LPCC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15046 MEADOW DR
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9034
Mailing Address - Country:US
Mailing Address - Phone:530-263-2075
Mailing Address - Fax:
Practice Address - Street 1:650 GOLD FLAT RD STE A
Practice Address - Street 2:
Practice Address - City:NEVADA CITY
Practice Address - State:CA
Practice Address - Zip Code:95959-3269
Practice Address - Country:US
Practice Address - Phone:530-648-0435
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPCC15865101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty