Provider Demographics
NPI:1659817575
Name:KURTZ, KEVIN RAY (LPC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:RAY
Last Name:KURTZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BX 1634
Mailing Address - Street 2:
Mailing Address - City:TOCCOA
Mailing Address - State:GA
Mailing Address - Zip Code:30577
Mailing Address - Country:US
Mailing Address - Phone:706-491-7064
Mailing Address - Fax:706-886-6599
Practice Address - Street 1:41 FALLS RD.
Practice Address - Street 2:
Practice Address - City:TOCCOA
Practice Address - State:GA
Practice Address - Zip Code:30577
Practice Address - Country:US
Practice Address - Phone:706-491-7064
Practice Address - Fax:706-886-6599
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-17
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02131595101YP1600X
GALPC009304101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral