Provider Demographics
NPI:1275333619
Name:CANTOS, KELLEY MARIE (AMFT)
Entity type:Individual
Prefix:
First Name:KELLEY
Middle Name:MARIE
Last Name:CANTOS
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31945 CORTEZ CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6296
Mailing Address - Country:US
Mailing Address - Phone:760-214-8802
Mailing Address - Fax:
Practice Address - Street 1:41669 WINCHESTER RD STE 101
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4872
Practice Address - Country:US
Practice Address - Phone:951-394-3772
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist