Healthcare Provider Details

I. General information

NPI: 1104358589
Provider Name (Legal Business Name): HOLLY KUHN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 W BALBOA BLVD
NEWPORT BEACH CA
92661-1037
US

IV. Provider business mailing address

2777 ALTON PKWY APT 407
IRVINE CA
92606-3155
US

V. Phone/Fax

Practice location:
  • Phone: 847-207-8806
  • Fax:
Mailing address:
  • Phone: 847-207-8806
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number32360
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: