Healthcare Provider Details

I. General information

NPI: 1124561444
Provider Name (Legal Business Name): ROGER J KUHN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2016
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17589 SUMMIT AVE
GUERNEVILLE CA
95446-8801
US

IV. Provider business mailing address

17589 SUMMIT AVE
GUERNEVILLE CA
95446-8801
US

V. Phone/Fax

Practice location:
  • Phone: 415-347-5454
  • Fax:
Mailing address:
  • Phone: 415-347-5454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number96853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: