Provider Demographics
NPI:1215785407
Name:KYLE-MARTINSEN, ALISA CHELSEA (LMFT)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:CHELSEA
Last Name:KYLE-MARTINSEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1940 20TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1201
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:FAGERSTRANDVEIEN 30
Practice Address - Street 2:
Practice Address - City:STABEKK
Practice Address - State:1368
Practice Address - Zip Code:VIKEN
Practice Address - Country:NO
Practice Address - Phone:415-509-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-11
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143212106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist