Healthcare Provider Details

I. General information

NPI: 1881855070
Provider Name (Legal Business Name): CARL FREDERICK KUGEL M.A., M.F.T.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 OCEAN AVE #230
SANTA MONICA CA
90401-2108
US

IV. Provider business mailing address

1551 OCEAN AVE #230
SANTA MONICA CA
90401-2108
US

V. Phone/Fax

Practice location:
  • Phone: 310-459-1782
  • Fax:
Mailing address:
  • Phone: 310-459-1782
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number29603
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: