Provider Demographics
NPI:1033663067
Name:KUTMAS, BRANDON ALAN (MS)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:ALAN
Last Name:KUTMAS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4709 44TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7187
Mailing Address - Country:US
Mailing Address - Phone:309-558-0258
Mailing Address - Fax:309-213-9438
Practice Address - Street 1:4709 44TH ST STE 5
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-7187
Practice Address - Country:US
Practice Address - Phone:309-306-1648
Practice Address - Fax:309-213-9438
Is Sole Proprietor?:No
Enumeration Date:2016-08-08
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health