Basic Information
| Provider Information | |||||||||
| NPI: | 1235546243 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAYNE | ||||||||
| FirstName: | ANASTACIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LMFT | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | KAYNE | ||||||||
| OtherFirstName: | STACY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 11731 TELEGRAPH RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11731 TELEGRAPH RD | ||||||||
| Address2: | SUITE G | ||||||||
| City: | SANTA FE SPRINGS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 906703675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5629428256 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2014 | ||||||||
| LastUpdateDate: | 11/02/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | IMF76907 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 102777 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.