Provider Demographics
NPI:1275831349
Name:KENT, JEFFREY HARLAN
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:HARLAN
Last Name:KENT
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 1:443 MINTON CT
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4025
Mailing Address - Country:US
Mailing Address - Phone:925-933-1203
Mailing Address - Fax:
Practice Address - Street 1:1286 CALLEN ST
Practice Address - Street 2:
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-3002
Practice Address - Country:US
Practice Address - Phone:707-447-8982
Practice Address - Fax:707-447-3205
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)