Healthcare Provider Details

I. General information

NPI: 1194872226
Provider Name (Legal Business Name): MICHAEL JOHN KOHNEN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 08/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5161 SOBRANTE AVE
EL SOBRANTE CA
94803-1639
US

IV. Provider business mailing address

5923 HARBOR VIEW AVE
SAN PABLO CA
94806-4239
US

V. Phone/Fax

Practice location:
  • Phone: 510-932-0138
  • Fax:
Mailing address:
  • Phone: 510-237-8654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number44533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: