Provider Demographics
NPI:1699543454
Name:WEST, KENNETH J (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:WEST
Suffix:
Gender:M
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:974 PALM TER
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91104-4502
Mailing Address - Country:US
Mailing Address - Phone:162-626-4035
Mailing Address - Fax:
Practice Address - Street 1:23415 CINEMA DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-1722
Practice Address - Country:US
Practice Address - Phone:626-817-3312
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT140351106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist