Healthcare Provider Details

I. General information

NPI: 1427594647
Provider Name (Legal Business Name): KUTNER THERAPY, AN INDIVIDUAL & FAMILY COUNSELING CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2017
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 CAMINO DEL RIO S SUITE 215
SAN DIEGO CA
92108-3808
US

IV. Provider business mailing address

3333 CAMINO DEL RIO S SUITE 215
SAN DIEGO CA
92108-3808
US

V. Phone/Fax

Practice location:
  • Phone: 619-607-8155
  • Fax: 619-610-9287
Mailing address:
  • Phone: 619-607-8155
  • Fax: 619-610-9287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number92589
License Number StateCA

VIII. Authorized Official

Name: MRS. KATE KUTNER
Title or Position: OWNER
Credential: LMFT
Phone: 619-607-8155