Provider Demographics
NPI:1326272816
Name:KUTASH, STEVEN BRANT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRANT
Last Name:KUTASH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 CENTRE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1849
Mailing Address - Country:US
Mailing Address - Phone:970-568-6323
Mailing Address - Fax:970-305-8322
Practice Address - Street 1:1030 CENTRE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1849
Practice Address - Country:US
Practice Address - Phone:970-568-6323
Practice Address - Fax:970-305-8322
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25921103TC0700X
COPSY.0004112103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical