Healthcare Provider Details

I. General information

NPI: 1730176470
Provider Name (Legal Business Name): DAWN LAVELLE KUFELD MS NCC LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DAWN LAVELLE CARRUTH

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 02/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 N TALL TREE DR
KINGMAN AZ
86401
US

IV. Provider business mailing address

9600 N TALL TREE DR
KINGMAN AZ
86401
US

V. Phone/Fax

Practice location:
  • Phone: 928-718-4800
  • Fax: 928-757-3256
Mailing address:
  • Phone: 928-263-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC1907
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLPC1907
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: