Provider Demographics
NPI:1285902072
Name:VALLEJO, KASSIE NICOLE (LMFT)
Entity type:Individual
Prefix:
First Name:KASSIE
Middle Name:NICOLE
Last Name:VALLEJO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:KASSIE
Other - Middle Name:NICOLE
Other - Last Name:MORENO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT INTERN
Mailing Address - Street 1:3105 WILSON ROAD
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93304-5246
Mailing Address - Country:US
Mailing Address - Phone:661-397-8775
Mailing Address - Fax:
Practice Address - Street 1:3105 WILSON ROAD
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4179
Practice Address - Country:US
Practice Address - Phone:661-397-8775
Practice Address - Fax:661-397-8286
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF73409106H00000X
CALMFT104527106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist