Provider Demographics
NPI:1407180375
Name:KUTZ, MARGARET ELAINE (LPD/LADC)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ELAINE
Last Name:KUTZ
Suffix:
Gender:F
Credentials:LPD/LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 N 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3473
Mailing Address - Country:US
Mailing Address - Phone:580-484-4059
Mailing Address - Fax:
Practice Address - Street 1:556 N 10TH ST
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3473
Practice Address - Country:US
Practice Address - Phone:580-484-4059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2408101Y00000X, 101YM0800X, 101YP2500X, 101YS0200X
OK324101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool