=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255722245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KUNO RUDOLPH BACHBAUER LMFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/11/2015
-----------------------------------------------------
Last Update Date | 02/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2604 CONNECTICUT AVE NW SUITE #200
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20008-1547
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-899-1833
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1107 NELSON ST SUITE #204
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-762-5866
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | LMFT000102
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------