Provider Demographics
NPI:1386743078
Name:VAILLANCOURT, KURT STEVEN (LMFT)
Entity type:Individual
Prefix:DR
First Name:KURT
Middle Name:STEVEN
Last Name:VAILLANCOURT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
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Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:8221 DE LONGPRE AVE.
Mailing Address - Street 2:APT. #22
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-3977
Mailing Address - Country:US
Mailing Address - Phone:310-991-5878
Mailing Address - Fax:866-352-1072
Practice Address - Street 1:9201 W SUNSET BLVD
Practice Address - Street 2:SUITE 718
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3701
Practice Address - Country:US
Practice Address - Phone:310-991-5878
Practice Address - Fax:866-352-1072
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAMFC37679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical