Provider Demographics
NPI:1073667200
Name:KENLEY, HOLLI RAE (MA)
Entity type:Individual
Prefix:MRS
First Name:HOLLI
Middle Name:RAE
Last Name:KENLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:35596 BUTTERFLY PEAK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92561-3067
Mailing Address - Country:US
Mailing Address - Phone:760-397-7978
Mailing Address - Fax:760-564-0300
Practice Address - Street 1:78150 CALLE TAMPICO
Practice Address - Street 2:SUITE 207A
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-2907
Practice Address - Country:US
Practice Address - Phone:760-397-7978
Practice Address - Fax:760-564-0300
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC39156106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist