Provider Demographics
NPI:1093904112
Name:KRUTZ, TAMRA MAE (LCPC)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:MAE
Last Name:KRUTZ
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:708 SUPERIOR ST STE B
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1633
Mailing Address - Country:US
Mailing Address - Phone:208-265-3579
Mailing Address - Fax:208-263-2576
Practice Address - Street 1:708 SUPERIOR ST STE B
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1633
Practice Address - Country:US
Practice Address - Phone:208-265-3579
Practice Address - Fax:208-263-2576
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2013-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health