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NPI Code Detail

MEDICARE: KEITH AARON KUTNAR PSYD

MEDICARE: KEITH AARON KUTNAR PSYD
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
1101YM0800XMental Health Counselor178.011414IL
2103TC0700XClinical Psychologist0006035CO

General Provider Information

NPI Number : 1689047730
Entity Type Code : Individual
Provider Name (Legal Business Name) : KEITH AARON KUTNAR PSYD
Provider Business Mailing Address
First Line : 2100 MANCHESTER RD
Second Line : SUITE 1510
City : WHEATON
State : IL
Zip : 60187-4579
Country : US
Telephone Number : 630-653-1717
Fax Number : 630-344-1087
Provider Business Practice Location Address
First Line : 1420 AUSTIN BLUFFS PKWY
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-3733
Country : US
Telephone Number : 719-255-4444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/10/2015
Last Update Date : 04/18/2023

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