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General NPI Number Information
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NPI Number | 1114434800
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Entity Type | Individual
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Provider Name | KEVIN KUNKEL MFT
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Gender | Male
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Dates
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Enumeration Date | 01/04/2018
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 122 LINCOLN BLVD STE 203
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City | VENICE
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State | CA
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Zip | 90291-2859
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Country | US
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Telephone | 310-691-9079
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Fax |
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Provider Business Mailing Address
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Address Line | 122 LINCOLN BLVD STE 203
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City | VENICE
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State | CA
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Zip | 90291-2859
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Country | US
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Telephone | 310-691-9079
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 94181
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License Number State | CA
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