Provider Demographics
NPI:1730341728
Name:KOZMA, KURT L (LMFT)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:L
Last Name:KOZMA
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 1:17663 COLONIAL CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-4562
Mailing Address - Country:US
Mailing Address - Phone:909-838-6981
Mailing Address - Fax:909-614-7421
Practice Address - Street 1:514 N CALIFORNIA AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-2113
Practice Address - Country:US
Practice Address - Phone:909-838-6981
Practice Address - Fax:909-614-7421
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23650106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist