Provider Demographics
NPI:1073799516
Name:KUENTZEL, JEFFREY GARTH (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:GARTH
Last Name:KUENTZEL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N MELBORN ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48128-1722
Mailing Address - Country:US
Mailing Address - Phone:313-600-9840
Mailing Address - Fax:313-577-8949
Practice Address - Street 1:383 FISHER RD
Practice Address - Street 2:
Practice Address - City:GROSSE POINTE
Practice Address - State:MI
Practice Address - Zip Code:48230-1674
Practice Address - Country:US
Practice Address - Phone:313-600-9840
Practice Address - Fax:313-577-8949
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-15
Last Update Date:2008-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011683103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical