Provider Demographics
NPI:1881739936
Name:THUVE, MARK KENNEDY
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:KENNEDY
Last Name:THUVE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2813 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5942
Mailing Address - Country:US
Mailing Address - Phone:951-737-2962
Mailing Address - Fax:951-737-2783
Practice Address - Street 1:31764 CASINO DR STE 200
Practice Address - Street 2:
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-4571
Practice Address - Country:US
Practice Address - Phone:951-471-4649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CAA052290218101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)