Provider Demographics
NPI:1639389463
Name:JOHNS, KURT DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:DAVID
Last Name:JOHNS
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 1:3926 EL CIMO LN NE
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-4049
Mailing Address - Country:US
Mailing Address - Phone:206-780-5151
Mailing Address - Fax:
Practice Address - Street 1:400 WINSLOW WAY E
Practice Address - Street 2:SUITE 190
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2402
Practice Address - Country:US
Practice Address - Phone:206-780-5151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00001294106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist