Provider Demographics
NPI:1043611056
Name:KEMTRUP, KRISTIAN HANS
Entity Type:Individual
Prefix:
First Name:KRISTIAN
Middle Name:HANS
Last Name:KEMTRUP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:902 CARMEL AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2106
Mailing Address - Country:US
Mailing Address - Phone:415-890-6585
Mailing Address - Fax:
Practice Address - Street 1:902 CARMEL AVE STE 5
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2106
Practice Address - Country:US
Practice Address - Phone:415-890-6585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123042106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist