Provider Demographics
NPI:1962149070
Name:PINCH, KYLAH JAY (APCC, AMFT)
Entity type:Individual
Prefix:
First Name:KYLAH
Middle Name:JAY
Last Name:PINCH
Suffix:
Gender:F
Credentials:APCC, AMFT
Other - Prefix:
Other - First Name:KYLE
Other - Middle Name:JEFFREY
Other - Last Name:PINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 COTTONWOOD ST STE 14
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-3603
Mailing Address - Country:US
Mailing Address - Phone:530-656-5080
Mailing Address - Fax:530-666-7682
Practice Address - Street 1:520 COTTONWOOD ST STE 14
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-3603
Practice Address - Country:US
Practice Address - Phone:530-656-5080
Practice Address - Fax:530-666-7682
Is Sole Proprietor?:No
Enumeration Date:2022-05-19
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16958101YP2500X
171M00000X, 101Y00000X, 172V00000X, 390200000X
CA148646106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No172V00000XOther Service ProvidersCommunity Health Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program