Provider Demographics
NPI:1699891366
Name:BRAINARD, KELLY ANNE (LMFT)
Entity type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ANNE
Last Name:BRAINARD
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:25129 THE OLD ROAD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381-2276
Mailing Address - Country:US
Mailing Address - Phone:661-294-3898
Mailing Address - Fax:661-294-3898
Practice Address - Street 1:25129 THE OLD ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-2276
Practice Address - Country:US
Practice Address - Phone:661-294-3898
Practice Address - Fax:661-294-3898
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAIMF 45082225400000X
CAMFC 44454106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner