Provider Demographics
NPI:1063560480
Name:KEVIN M. KILBANE, L.M.F.T., INC.
Entity type:Organization
Organization Name:KEVIN M. KILBANE, L.M.F.T., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KILBANE
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:562-424-8503
Mailing Address - Street 1:3815 ATLANTIC AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3500
Mailing Address - Country:US
Mailing Address - Phone:562-424-8503
Mailing Address - Fax:562-424-8772
Practice Address - Street 1:3815 ATLANTIC AVE STE 2
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3500
Practice Address - Country:US
Practice Address - Phone:562-424-8503
Practice Address - Fax:562-424-8772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36992106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty