Provider Demographics
NPI:1053082008
Name:KUNTZ, QUENTIN PAUL (LLP)
Entity Type:Individual
Prefix:
First Name:QUENTIN
Middle Name:PAUL
Last Name:KUNTZ
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2471 EATON RD.
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-4336
Mailing Address - Country:US
Mailing Address - Phone:216-973-0204
Mailing Address - Fax:
Practice Address - Street 1:2226 S. AIRPORT RD. WEST
Practice Address - Street 2:SUITE A
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4706
Practice Address - Country:US
Practice Address - Phone:231-947-2442
Practice Address - Fax:231-947-2446
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6361003367103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist