Healthcare Provider Details

I. General information

NPI: 1013291582
Provider Name (Legal Business Name): MRS. BLYTHE L KUTTLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

323 N PRAIRIE AVENUE
INGLEWOOD CA
90301
US

IV. Provider business mailing address

4760 SEPULVEDA BLVD.
CULVER CITY CA
90230
US

V. Phone/Fax

Practice location:
  • Phone: 310-846-2139
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number71710
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: