Provider Demographics
NPI:1306654090
Name:WILLIBY, KENDRA (PSYD)
Entity type:Individual
Prefix:
First Name:KENDRA
Middle Name:
Last Name:WILLIBY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15030 VENTURA BLVD STE 11-282
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-5470
Mailing Address - Country:US
Mailing Address - Phone:206-802-8424
Mailing Address - Fax:
Practice Address - Street 1:15310 ARCHWOOD ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406-6302
Practice Address - Country:US
Practice Address - Phone:206-802-8424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-26
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY35470103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical