Provider Demographics
NPI:1396174066
Name:FLORES, JESSICA KUTZ (MA-LPAT)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:KUTZ
Last Name:FLORES
Suffix:
Gender:F
Credentials:MA-LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1451 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40208-2203
Mailing Address - Country:US
Mailing Address - Phone:502-386-1938
Mailing Address - Fax:
Practice Address - Street 1:1451 S 6TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-2203
Practice Address - Country:US
Practice Address - Phone:502-386-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-0135101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional