Healthcare Provider Details

I. General information

NPI: 1639247281
Provider Name (Legal Business Name): NEAL WALTER KUHLHORST M.DIV. LMFT CIRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 BELL RD
DULUTH GA
30097-1908
US

IV. Provider business mailing address

10950 BELL ROAD
DULTUH GA
30097
US

V. Phone/Fax

Practice location:
  • Phone: 678-467-4909
  • Fax: 770-813-8605
Mailing address:
  • Phone: 678-467-4909
  • Fax: 770-813-8605

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number825
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: