Provider Demographics
NPI:1467554725
Name:DUGAN, KEVIN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:DUGAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BRUNSWICK RD.
Mailing Address - Street 2:STE. 10
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-272-6231
Mailing Address - Fax:530-272-6294
Practice Address - Street 1:565 BRUNSWICK RD.
Practice Address - Street 2:STE. 10
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-272-6231
Practice Address - Fax:530-272-6294
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19569103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical