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NPI Code Detail

MEDICARE: MR. GLENN EDWARD KUTZLI MA LPC

MEDICARE: MR. GLENN EDWARD KUTZLI MA LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2101YM0800XMental Health Counselor6401008162MI
3101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1043492176
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GLENN EDWARD KUTZLI MA LPC
Provider Business Mailing Address
First Line : 3333 36TH ST SE
Second Line :
City : KENTWOOD
State : MI
Zip : 49512-2809
Country : US
Telephone Number : 616-954-3540
Fax Number :
Provider Business Practice Location Address
First Line : 3333 36TH ST SE
Second Line :
City : KENTWOOD
State : MI
Zip : 49512-2809
Country : US
Telephone Number : 616-954-3540
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/30/2007
Last Update Date : 10/01/2025

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