Provider Demographics
NPI:1780891291
Name:KIEHN, DONALD WALTER (LMFT)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:WALTER
Last Name:KIEHN
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 1:445 BELLEVUE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4923
Mailing Address - Country:US
Mailing Address - Phone:510-531-4351
Mailing Address - Fax:510-835-1147
Practice Address - Street 1:445 BELLEVUE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4923
Practice Address - Country:US
Practice Address - Phone:510-531-4351
Practice Address - Fax:510-835-1147
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT25613106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008166Medicaid