Provider Demographics
NPI:1861882680
Name:KOHAN, EVELYN GAIL (PHD)
Entity type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:GAIL
Last Name:KOHAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:EVELYN
Other - Middle Name:KOHAN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:23622 CALABASAS RD
Mailing Address - Street 2:SUITE 252
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1549
Mailing Address - Country:US
Mailing Address - Phone:818-222-8813
Mailing Address - Fax:
Practice Address - Street 1:23622 CALABASAS RD
Practice Address - Street 2:SUITE 252
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1549
Practice Address - Country:US
Practice Address - Phone:818-222-8813
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-01
Last Update Date:2015-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7237103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical