Provider Demographics
NPI:1851956460
Name:FARRISE, KAELA
Entity type:Individual
Prefix:
First Name:KAELA
Middle Name:
Last Name:FARRISE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 WEBSTER ST UNIT 5762
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-5048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:THE GEVIRTZ SCHOOL
Practice Address - Street 2:UNIVERSITY OF CALIFORNIA, SANTA BARBARA
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93106-9490
Practice Address - Country:US
Practice Address - Phone:323-285-1595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-08
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123016106H00000X
CA16092101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health