MEDICARE: ADAM CHASE KAHN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	86416	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700928033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADAM CHASE KAHN LMFT

Provider Business Mailing Address
First Line	:	223 WILSON ST
Second Line	:
City	:	PETALUMA
State	:	CA
Zip	:	94952-3139
Country	:	US
Telephone Number	:	510-929-1927
Fax Number	:	510-306-2717

Provider Business Practice Location Address
First Line	:	3101 TELEGRAPH AVE
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-1984
Country	:	US
Telephone Number	:	510-929-1927
Fax Number	:	510-306-2717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2007
Last Update Date	:	11/30/2019

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