MEDICARE: MR. JOHN G KUTINAC JR. MA PA LPCC

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	103T00000X	Psychologist	PA9501	NM
2	101YP2500X	Professional Counselor	1157	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1508844135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN G KUTINAC JR. MA PA LPCC

Provider Business Mailing Address
First Line	:	1155 S TELSHOR BLVD
Second Line	:	STE 200
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1009
Country	:	US
Telephone Number	:	505-522-8002
Fax Number	:	505-522-8027

Provider Business Practice Location Address
First Line	:	1155 S TELSHOR BLVD
Second Line	:	STE 200
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-1009
Country	:	US
Telephone Number	:	505-522-8002
Fax Number	:	505-522-8027

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

Provider Enumeration Date	:	01/04/2006
Last Update Date	:	09/11/2025

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