Provider Demographics
NPI:1972660504
Name:ATHEY, KENNETH JAMES (MS MFT)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:JAMES
Last Name:ATHEY
Suffix:
Gender:M
Credentials:MS MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 WASHINGTON ST
Mailing Address - Street 2:BOX 52
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4029
Mailing Address - Country:US
Mailing Address - Phone:510-332-0491
Mailing Address - Fax:
Practice Address - Street 1:21847 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-6435
Practice Address - Country:US
Practice Address - Phone:510-332-0491
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist