Healthcare Provider Details

I. General information

NPI: 1821012279
Provider Name (Legal Business Name): JOHN CHRISTOPHER KUGHN MFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 09/02/2021
Certification Date: 09/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

IV. Provider business mailing address

201 ALAMEDA DEL PRADO STE 103
NOVATO CA
94949-6698
US

V. Phone/Fax

Practice location:
  • Phone: 415-457-6964
  • Fax: 415-721-0281
Mailing address:
  • Phone: 415-457-6966
  • Fax: 415-721-0821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37183
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37183
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: