Provider Demographics
NPI:1730224791
Name:PETERSON-KAHN, CANDACE J (MFT)
Entity type:Individual
Prefix:MS
First Name:CANDACE
Middle Name:J
Last Name:PETERSON-KAHN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CANDACE
Other - Middle Name:J
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 3851
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1717
Mailing Address - Country:US
Mailing Address - Phone:310-787-1500
Mailing Address - Fax:310-787-9713
Practice Address - Street 1:370 CRENSHAW BLVD
Practice Address - Street 2:SUITE E100
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-1727
Practice Address - Country:US
Practice Address - Phone:310-787-1500
Practice Address - Fax:310-787-9713
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist