Provider Demographics
NPI:1285332841
Name:KULLA-MADER, HANS MICHAEL (MA, AMFT)
Entity type:Individual
Prefix:MR
First Name:HANS
Middle Name:MICHAEL
Last Name:KULLA-MADER
Suffix:
Gender:M
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:162 WADSWORTH AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-2547
Mailing Address - Country:US
Mailing Address - Phone:310-702-8356
Mailing Address - Fax:
Practice Address - Street 1:960 WEST GRAND AVE
Practice Address - Street 2:SUITE K
Practice Address - City:ARROYO GRANDE
Practice Address - State:CA
Practice Address - Zip Code:93420
Practice Address - Country:US
Practice Address - Phone:760-889-9827
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-22
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT135597106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty