Provider Demographics
NPI:1386025096
Name:JOHN G KUTINAC, INC
Entity Type:Organization
Organization Name:JOHN G KUTINAC, INC
Other - Org Name:LAS CRUCES COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:KUTINAC
Authorized Official - Suffix:JR
Authorized Official - Credentials:MA PA LPCC
Authorized Official - Phone:575-522-8002
Mailing Address - Street 1:1155 S TELSHOR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1009
Mailing Address - Country:US
Mailing Address - Phone:575-522-8002
Mailing Address - Fax:575-522-8027
Practice Address - Street 1:1155 S TELSHOR BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1009
Practice Address - Country:US
Practice Address - Phone:575-522-8002
Practice Address - Fax:575-522-8027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA9501103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty