Healthcare Provider Details

I. General information

NPI: 1780807297
Provider Name (Legal Business Name): C THOMAS KUTZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

IV. Provider business mailing address

4879 E KINGS CANYON RD
FRESNO CA
93727-3811
US

V. Phone/Fax

Practice location:
  • Phone: 559-255-8395
  • Fax: 559-452-8194
Mailing address:
  • Phone: 559-255-8395
  • Fax: 559-452-8194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS-4209
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: