MEDICARE: MKB THERAPY, MKB, LLC

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
1	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1225983760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MKB THERAPY, MKB, LLC

Provider Business Mailing Address
First Line	:	3673 IRONWOOD DR
Second Line	:
City	:	ALAMOGORDO
State	:	NM
Zip	:	88310-5485
Country	:	US
Telephone Number	:	575-415-5612
Fax Number	:

Provider Business Practice Location Address
First Line	:	1209 MOUNTAIN ROAD PL NE STE R
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7845
Country	:	US
Telephone Number	:	505-456-4212
Fax Number	:

Authorized Official
Title or Position	:	OWNER/LEAD THERAPIST
Name	:	MARYLOUISE TINEKE KUTI
Credential	:	LCSW
Telephone Number	:	575-415-5612

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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