Provider Demographics
NPI:1063890762
Name:CURTIS, KEN
Entity type:Individual
Prefix:
First Name:KEN
Middle Name:
Last Name:CURTIS
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 1:2901 4TH ST APT 322
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-5514
Mailing Address - Country:US
Mailing Address - Phone:310-344-7573
Mailing Address - Fax:
Practice Address - Street 1:2901 4TH ST APT 322
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-5514
Practice Address - Country:US
Practice Address - Phone:310-344-7573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-13
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst