Provider Demographics
NPI:1235600669
Name:KOHL, ALYSON REYNOLDS (MFT)
Entity Type:Individual
Prefix:
First Name:ALYSON
Middle Name:REYNOLDS
Last Name:KOHL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:DABBS
Other - Last Name:REYNOLDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2323 CHURN CREEK RD UNIT 492102
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96049-5328
Mailing Address - Country:US
Mailing Address - Phone:530-638-3368
Mailing Address - Fax:
Practice Address - Street 1:2628 VICTOR AVE STE C
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-1454
Practice Address - Country:US
Practice Address - Phone:530-638-3368
Practice Address - Fax:530-653-2332
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33101106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist