Provider Demographics
NPI:1871323238
Name:WEEKES, KENNETH LOUIS (AMFT, APCC, LAADC)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:LOUIS
Last Name:WEEKES
Suffix:
Gender:M
Credentials:AMFT, APCC, LAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 SCHAEFER AVE STE K
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5456
Mailing Address - Country:US
Mailing Address - Phone:909-910-3234
Mailing Address - Fax:
Practice Address - Street 1:8058 LA MESA BLVD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-0335
Practice Address - Country:US
Practice Address - Phone:858-848-1766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA127367106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist