Provider Demographics
NPI:1245709328
Name:DAVID J. KUTZ, PHD, CONSULTANTS PC
Entity type:Organization
Organization Name:DAVID J. KUTZ, PHD, CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-903-3106
Mailing Address - Street 1:2074 GALISTEO ST STE A1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-2104
Mailing Address - Country:US
Mailing Address - Phone:505-903-3106
Mailing Address - Fax:
Practice Address - Street 1:2074 GALISTEO ST STE A1
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-2104
Practice Address - Country:US
Practice Address - Phone:505-903-3106
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-18
Last Update Date:2018-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)