Provider Demographics
NPI:1568608008
Name:COUSINS, KURT L (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:L
Last Name:COUSINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 NORTHLAND DR STE 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4955
Mailing Address - Country:US
Mailing Address - Phone:512-701-1490
Mailing Address - Fax:843-631-2079
Practice Address - Street 1:3303 NORTHLAND DR STE 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4955
Practice Address - Country:US
Practice Address - Phone:512-701-1490
Practice Address - Fax:843-631-2079
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT1930572084P0800X
TXP72612084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry