Provider Demographics
NPI:1700928033
Name:KAHN, ADAM CHASE (LMFT)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:CHASE
Last Name:KAHN
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 1:223 WILSON ST
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-3139
Mailing Address - Country:US
Mailing Address - Phone:510-929-1927
Mailing Address - Fax:510-306-2717
Practice Address - Street 1:3101 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1984
Practice Address - Country:US
Practice Address - Phone:510-929-1927
Practice Address - Fax:510-306-2717
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2019-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86416106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700928033Medicaid