Provider Demographics
NPI:1376953067
Name:VON LUFT, KEVIN (MA)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:VON LUFT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 W MAIN ST STE 101
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7711
Mailing Address - Country:US
Mailing Address - Phone:949-275-8804
Mailing Address - Fax:
Practice Address - Street 1:222 W MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7711
Practice Address - Country:US
Practice Address - Phone:949-275-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-02
Last Update Date:2014-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF78050101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health