Provider Demographics
NPI:1992533798
Name:MALZ, KIMBERLY MAE (AMFT138088)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MAE
Last Name:MALZ
Suffix:
Gender:F
Credentials:AMFT138088
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 624
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-0624
Mailing Address - Country:US
Mailing Address - Phone:818-275-2353
Mailing Address - Fax:
Practice Address - Street 1:12631 IMPERIAL HWY STE C103
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670-6735
Practice Address - Country:US
Practice Address - Phone:818-275-2353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist