Provider Demographics
NPI:1508880667
Name:KIEHNE, GARY OSCAR (PSYD MFT)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:OSCAR
Last Name:KIEHNE
Suffix:
Gender:M
Credentials:PSYD MFT
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Other - First Name:
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Mailing Address - Street 1:926A DIABLO AVE
Mailing Address - Street 2:BOX 309
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94947-4000
Mailing Address - Country:US
Mailing Address - Phone:415-328-3598
Mailing Address - Fax:415-339-7442
Practice Address - Street 1:926A DIABLO AVE
Practice Address - Street 2:BOX 309
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94947-4000
Practice Address - Country:US
Practice Address - Phone:415-328-3598
Practice Address - Fax:415-339-7442
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-03-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 19610103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist