Provider Demographics
NPI:1629090667
Name:RUTTER, KEVIN M (MS, LMFT)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:M
Last Name:RUTTER
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Mailing Address - Street 2:
Mailing Address - City:CONOVER
Mailing Address - State:NC
Mailing Address - Zip Code:28613-9289
Mailing Address - Country:US
Mailing Address - Phone:828-638-5907
Mailing Address - Fax:828-322-2280
Practice Address - Street 1:715 FAIRGROVE CHURCH RD SE STE 202
Practice Address - Street 2:
Practice Address - City:CONOVER
Practice Address - State:NC
Practice Address - Zip Code:28613-9289
Practice Address - Country:US
Practice Address - Phone:828-638-5907
Practice Address - Fax:828-322-2280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC851106H00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6105243Medicaid