Provider Demographics
NPI:1326010851
Name:KUNTZ, CAROL BETTY (PYSD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:BETTY
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 86370
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57118-6370
Mailing Address - Country:US
Mailing Address - Phone:605-322-7510
Mailing Address - Fax:605-322-6475
Practice Address - Street 1:4400 W 69TH ST
Practice Address - Street 2:STE 1500
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8170
Practice Address - Country:US
Practice Address - Phone:605-322-5700
Practice Address - Fax:605-322-5704
Is Sole Proprietor?:No
Enumeration Date:2006-02-07
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD348103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD0040473OtherBLUE CROSS
MN120166OtherUCARE
SD27178OtherSANFORD HEALTH PLAN
NE46022474352Medicaid
MN50M79KUOtherCC SYSTEMS/ BLUE PLUS
SD680015877OtherRR MEDICARE
SD6550452Medicaid
SDP347OtherDAKOTACARE
MN040121002OtherPRIMEWEST
SD412991028112OtherPREFERRED ONE
SD10648OtherMIDLANDS CHOICE
ND12200Medicaid
IA1958108Medicaid
SDHP24863OtherHEALTHPARTNERS
SD26448OtherARAZ/ AMERICA'S PPO
SD57108C026OtherWPS TRICARE
MN926822700Medicaid
SDR59271Medicare UPIN
MN926822700Medicaid