Provider Demographics
NPI:1538441639
Name:KUHL, JUSTIN RAY-EDWARD
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:RAY-EDWARD
Last Name:KUHL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 S BAY PORT RD
Mailing Address - Street 2:
Mailing Address - City:BAY PORT
Mailing Address - State:MI
Mailing Address - Zip Code:48720-9725
Mailing Address - Country:US
Mailing Address - Phone:989-798-8810
Mailing Address - Fax:
Practice Address - Street 1:1 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SEBEWAING
Practice Address - State:MI
Practice Address - Zip Code:48759-1319
Practice Address - Country:US
Practice Address - Phone:989-798-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-14
Last Update Date:2019-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401017258101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional