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General NPI Number Information
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NPI Number | 1972660504
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Entity Type | Individual
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Provider Name | KENNETH JAMES ATHEY MS MFT
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Gender | Male
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Dates
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Enumeration Date | 01/02/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 21847 REDWOOD RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-6435
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Country | US
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Telephone | 510-332-0491
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Fax |
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Provider Business Mailing Address
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Address Line | 815 WASHINGTON ST BOX 52
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City | OAKLAND
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State | CA
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Zip | 94607-4029
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Country | US
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Telephone | 510-332-0491
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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 |
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License Number State |
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