Healthcare Provider Details

I. General information

NPI: 1871876540
Provider Name (Legal Business Name): FREDERICK HARRIS KUTTNER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2011
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 FRONT ST STE 200
SANTA CRUZ CA
95060-4538
US

IV. Provider business mailing address

518 MILL POND DR
SAN JOSE CA
95125-1413
US

V. Phone/Fax

Practice location:
  • Phone: 831-588-5335
  • Fax:
Mailing address:
  • Phone: 831-588-5335
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA11146
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: