1770791295 NPI number — PETER JOSEPH KAHN PH.D.

Table of content: (NPI 1265553663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770791295 NPI number — PETER JOSEPH KAHN PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KAHN
Provider First Name:
PETER
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770791295
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CARRUTH CENTER FOR COUNSELING, COLLEGE AVE.
Provider Second Line Business Mailing Address:
RM 303 STUDENT SERVICES CENTER BUILDING
Provider Business Mailing Address City Name:
MORGANTOWN
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
26506-6422
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-293-4431
Provider Business Mailing Address Fax Number:
304-293-3705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CARRUTH CENTER FOR COUNSELING, COLLEGE AVE.
Provider Second Line Business Practice Location Address:
RM 303 STUDENT SERVICES CENTER BUILDING
Provider Business Practice Location Address City Name:
MORGANTOWN
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
26506-6422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-293-4431
Provider Business Practice Location Address Fax Number:
304-293-3705
Provider Enumeration Date:
05/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  814 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 814 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)