Provider Demographics
NPI:1629395181
Name:CUNDICK, KIRT (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIRT
Middle Name:
Last Name:CUNDICK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 N HILL FIELD RD STE 3
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-5061
Mailing Address - Country:US
Mailing Address - Phone:801-784-6894
Mailing Address - Fax:866-288-9097
Practice Address - Street 1:1454 N HILL FIELD RD STE 3
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-5061
Practice Address - Country:US
Practice Address - Phone:801-784-6894
Practice Address - Fax:866-288-9097
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5545558-2501103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical