Provider Demographics
NPI:1063167765
Name:KOUZMOV, PETER (MFT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:KOUZMOV
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 TIOGA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94134-2241
Mailing Address - Country:US
Mailing Address - Phone:415-570-2965
Mailing Address - Fax:
Practice Address - Street 1:50 TIOGA AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94134-2241
Practice Address - Country:US
Practice Address - Phone:510-939-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-21
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002277106H00000X
CA129320106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist