Provider Demographics
NPI:1083668487
Name:MICHAEL, KURT D (PHD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:D
Last Name:MICHAEL
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 1:222 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5067
Mailing Address - Country:US
Mailing Address - Phone:828-264-6512
Mailing Address - Fax:828-264-6512
Practice Address - Street 1:222 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5067
Practice Address - Country:US
Practice Address - Phone:828-264-6512
Practice Address - Fax:828-264-6512
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2802103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent