Provider Demographics
NPI:1568520922
Name:DVOREN, KEN NEIL (LMFT)
Entity Type:Individual
Prefix:MR
First Name:KEN
Middle Name:NEIL
Last Name:DVOREN
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 18TH ST
Mailing Address - Street 2:#5
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404
Mailing Address - Country:US
Mailing Address - Phone:310-392-2536
Mailing Address - Fax:443-308-2536
Practice Address - Street 1:2812 SANTA MONICA BLVD
Practice Address - Street 2:#205
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2476
Practice Address - Country:US
Practice Address - Phone:310-392-2536
Practice Address - Fax:443-308-2536
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8236106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist