Provider Demographics
NPI:1750466751
Name:KUGHN, ELIZABETH STOLZ (MFT)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:STOLZ
Last Name:KUGHN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1634 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-1809
Mailing Address - Country:US
Mailing Address - Phone:415-721-4555
Mailing Address - Fax:
Practice Address - Street 1:1634 5TH AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-1809
Practice Address - Country:US
Practice Address - Phone:415-721-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36942106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist