Provider Demographics
NPI:1578695243
Name:KURTZ, THOMAS L (MA)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:KURTZ
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2790 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5337
Mailing Address - Country:US
Mailing Address - Phone:719-444-0250
Mailing Address - Fax:719-444-0253
Practice Address - Street 1:2790 N ACADEMY BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5337
Practice Address - Country:US
Practice Address - Phone:719-444-0250
Practice Address - Fax:719-444-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO512101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional