Healthcare Provider Details

I. General information

NPI: 1316149313
Provider Name (Legal Business Name): MR. SCOTT KUGLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 I ST
DAVIS CA
95616-4213
US

IV. Provider business mailing address

1420 LAKE BLVD APT 24
DAVIS CA
95616-2695
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-4078
  • Fax: 530-758-1685
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: