Basic Information
| Provider Information | |||||||||
| NPI: | 1306905492 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KAYES | ||||||||
| FirstName: | MAX | ||||||||
| MiddleName: | JAMES | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12810 HEACOCK ST STE B202 | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925532873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512476542 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12810 HEACOCK ST STE B202 | ||||||||
| Address2: | |||||||||
| City: | MORENO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925532873 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512476542 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 03/14/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC22998 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.