Healthcare Provider Details

I. General information

NPI: 1992014633
Provider Name (Legal Business Name): LARRY KUHN PSYD, HSPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2010
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5361 N 700 E
CHURUBUSCO IN
46723-9323
US

IV. Provider business mailing address

5361 N 700 E
CHURUBUSCO IN
46723-9323
US

V. Phone/Fax

Practice location:
  • Phone: 949-275-8804
  • Fax:
Mailing address:
  • Phone: 949-275-8804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY24067
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number20042828A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: