MEDICARE: MR. CLOUD K KURTIN LBSW

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	101YM0800X	Mental Health Counselor	25913	TX
2	101YP2500X	Professional Counselor	25913	VT

General Provider Information

NPI Number	:	1285742114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CLOUD K KURTIN LBSW

Provider Business Mailing Address
First Line	:	3501 RENZEL BLVD
Second Line	:	#352
City	:	FT WORTH
State	:	TX
Zip	:	76116
Country	:	US
Telephone Number	:	817-995-7434
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 OAKLAND BLVD
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76103
Country	:	US
Telephone Number	:	817-429-2290
Fax Number	:	817-451-8114

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	09/11/2025

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Directions to “ MR. CLOUD K KURTIN LBSW” Practice Location

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