Provider Demographics
NPI:1639240781
Name:KOHN, JOHN DEXTER (LLPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DEXTER
Last Name:KOHN
Suffix:
Gender:M
Credentials:LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 CALLE DE LEON
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7303
Mailing Address - Country:US
Mailing Address - Phone:505-982-8735
Mailing Address - Fax:505-982-0264
Practice Address - Street 1:615 CALLE DE LEON
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7303
Practice Address - Country:US
Practice Address - Phone:505-982-8735
Practice Address - Fax:505-982-0264
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB8875Medicaid