Basic Information
| Provider Information | |||||||||
| NPI: | 1851874457 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JORY | ||||||||
| FirstName: | KENDALL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4001 MISSION OAKS BLVD STE I | ||||||||
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| City: | CAMARILLO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 930125121 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 429 N SAN ANTONIO RD | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931101399 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058841600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/10/2018 | ||||||||
| LastUpdateDate: | 10/05/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | AMFT118142 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.