Provider Demographics
NPI:1851591556
Name:KUNTZ, JUDITH ANN (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:ANN
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO B0X 563
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070
Mailing Address - Country:US
Mailing Address - Phone:503-841-8943
Mailing Address - Fax:503-925-1897
Practice Address - Street 1:8855 SW HOLLY LANE
Practice Address - Street 2:SUITE 106
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070
Practice Address - Country:US
Practice Address - Phone:503-481-8943
Practice Address - Fax:503-925-1897
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2007-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT0453106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist