Provider Demographics
NPI:1992255277
Name:WEHE, KEVIN (LMFT)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:WEHE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 LARRABEE ST
Mailing Address - Street 2:#123
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-3958
Mailing Address - Country:US
Mailing Address - Phone:301-704-7347
Mailing Address - Fax:
Practice Address - Street 1:960 LARRABEE ST
Practice Address - Street 2:#123
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-3958
Practice Address - Country:US
Practice Address - Phone:301-704-7347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-10
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist