Provider Demographics
NPI:1639283617
Name:KAHN, SUSAN RAE (MFT)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:RAE
Last Name:KAHN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:SUSAN
Other - Middle Name:RAE
Other - Last Name:RYAVE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:4240 LOST HILLS ROAD
Mailing Address - Street 2:#2501
Mailing Address - City:CALABASAS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301
Mailing Address - Country:US
Mailing Address - Phone:818-750-7777
Mailing Address - Fax:818-878-0308
Practice Address - Street 1:141 N. DUESENBERG DRIVE
Practice Address - Street 2:SUITE 9
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362
Practice Address - Country:US
Practice Address - Phone:818-750-7777
Practice Address - Fax:818-878-0308
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
CAMFC31659106H00000X
CAMFT31659106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist