Provider Demographics
NPI:1861278053
Name:KUK, EFRAIN CONCEPCION (LMFT)
Entity type:Individual
Prefix:
First Name:EFRAIN
Middle Name:CONCEPCION
Last Name:KUK
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:PO BOX 63203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90063-0203
Mailing Address - Country:US
Mailing Address - Phone:323-712-9234
Mailing Address - Fax:
Practice Address - Street 1:806 N FRESNO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90063-4013
Practice Address - Country:US
Practice Address - Phone:323-712-9234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA136018101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health