Basic Information
| Provider Information | |||||||||
| NPI: | 1528465705 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAHN | ||||||||
| FirstName: | JACOB | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 158 INVERNESS DR W | ||||||||
| Address2: | #B 302 | ||||||||
| City: | ENGLEWOOD | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801125026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405354850 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2460 S VINE ST | ||||||||
| Address2: | (303) 871-3736 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802105264 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3038713736 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2014 | ||||||||
| LastUpdateDate: | 12/03/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.