Provider Demographics
NPI:1194887299
Name:KOLHOVEN, JOHN W
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:W
Last Name:KOLHOVEN
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 1:5755 MOUNTAIN HAWK DR
Mailing Address - Street 2:SUITE 205A
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409-4450
Mailing Address - Country:US
Mailing Address - Phone:707-321-8650
Mailing Address - Fax:
Practice Address - Street 1:5755 MOUNTAIN HAWK DR
Practice Address - Street 2:SUITE 205 A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409-4450
Practice Address - Country:US
Practice Address - Phone:707-321-8650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20874103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling