Provider Demographics
NPI:1770791295
Name:KAHN, PETER JOSEPH (PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:KAHN
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:CARRUTH CENTER FOR COUNSELING, COLLEGE AVE.
Mailing Address - Street 2:RM 303 STUDENT SERVICES CENTER BUILDING
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26506-6422
Mailing Address - Country:US
Mailing Address - Phone:304-293-4431
Mailing Address - Fax:304-293-3705
Practice Address - Street 1:CARRUTH CENTER FOR COUNSELING, COLLEGE AVE.
Practice Address - Street 2:RM 303 STUDENT SERVICES CENTER BUILDING
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26506-6422
Practice Address - Country:US
Practice Address - Phone:304-293-4431
Practice Address - Fax:304-293-3705
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV814103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical