Provider Demographics
NPI:1366644593
Name:WADE KUNST, JEAN JORDAN (MA, MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:JORDAN
Last Name:WADE KUNST
Suffix:
Gender:F
Credentials:MA, MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30998 COUNTY ROAD 29A
Mailing Address - Street 2:
Mailing Address - City:WINTERS
Mailing Address - State:CA
Mailing Address - Zip Code:95694-9021
Mailing Address - Country:US
Mailing Address - Phone:530-795-0617
Mailing Address - Fax:
Practice Address - Street 1:936 G STREET
Practice Address - Street 2:PARKSIDE FIRST UNITED METHODIST CHURCH
Practice Address - City:WILLIAMS
Practice Address - State:CA
Practice Address - Zip Code:95987
Practice Address - Country:US
Practice Address - Phone:530-902-4899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-01
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20569106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist