Provider Demographics
NPI:1629447974
Name:HARA, KYLE T
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:T
Last Name:HARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8337 TELEGRAPH RD STE 115
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4940
Mailing Address - Country:US
Mailing Address - Phone:714-310-0529
Mailing Address - Fax:
Practice Address - Street 1:8337 TELEGRAPH RD STE 115
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4940
Practice Address - Country:US
Practice Address - Phone:562-207-4272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124856106H00000X
CA85252106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist