Provider Demographics
NPI:1932544590
Name:REUTTER, KIRBY K (PHD LMHC)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:K
Last Name:REUTTER
Suffix:
Gender:M
Credentials:PHD LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 125
Mailing Address - Street 2:14505 KLOPFENSTEIN ROAD,
Mailing Address - City:LEO
Mailing Address - State:IN
Mailing Address - Zip Code:46765
Mailing Address - Country:US
Mailing Address - Phone:260-627-2159
Mailing Address - Fax:260-627-3601
Practice Address - Street 1:14505 KLOPFENSTEIN ROAD
Practice Address - Street 2:
Practice Address - City:LEO
Practice Address - State:IN
Practice Address - Zip Code:46765
Practice Address - Country:US
Practice Address - Phone:260-627-2159
Practice Address - Fax:260-627-3601
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2013-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39002367A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health