NPIMap

Organization Active NPI

Kendall Individual Family and Marriage Therapists Inc

  • Marriage & Family Therapist
  • Santa Rosa, CA
National Provider Identifier
1740830389
Registry record updated Jul 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
Legal business name
KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC
Practice address
1622 4TH St
Santa Rosa, CA 95404-4020
Phone
(707) 571-1714
NPI assigned
Sep 16, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joy Lyn Kendall, LMFTNPI 1891195525
Title
President/Owner
Phone
(707) 535-6615

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Marriage & Family TherapistGroup: 193200000X MULTI-SPECIALTY GROUP 106H00000X Primary

Addresses

Primary practice location

1622 4TH St
Santa Rosa, CA 95404-4020

Mailing address

1622 4TH St
Santa Rosa, CA 95404-4020
Phone (707) 535-6615

Other names 1

  • FOURTH STREET CHRISTIAN THERAPISTS Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240725004831 CA Part B Supplier - Clinic/Group Practice 5890231872 Receives reassigned benefits from 5 practitioners
Practice locations: Santa Rosa, CA

National Provider Directory

National Provider Directory

Locations

1622 4th St
Santa Rosa, CA 95404
Phone (707) 216-1758

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1568592000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1721692800000",
    "number": "1740830389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1622 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044020",
            "telephone_number": "707-535-6615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1622 4TH ST",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954044020",
            "telephone_number": "707-571-1714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENDALL INDIVIDUAL FAMILY AND MARRIAGE THERAPISTS INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-16",
        "last_updated": "2024-07-23",
        "certification_date": "2024-07-23",
        "status": "A",
        "authorized_official_last_name": "KENDALL",
        "authorized_official_first_name": "JOY",
        "authorized_official_middle_name": "LYN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "707-535-6615",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FOURTH STREET CHRISTIAN THERAPISTS",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Santa Rosa, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.