Provider Demographics
NPI:1285071191
Name:MUKANZU, KACHIMBE D
Entity type:Individual
Prefix:MR
First Name:KACHIMBE
Middle Name:D
Last Name:MUKANZU
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 1:4051 KINGS ROW
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-6825
Mailing Address - Country:US
Mailing Address - Phone:775-622-4798
Mailing Address - Fax:
Practice Address - Street 1:4051 KINGS ROW
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-6825
Practice Address - Country:US
Practice Address - Phone:775-622-4798
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor