Healthcare Provider Details

I. General information

NPI: 1679143846
Provider Name (Legal Business Name): JAMIE LEE KUNTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2021
Last Update Date: 03/11/2024
Certification Date: 12/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRAN CIR B7500
FORT CARSON CO
80913-4263
US

IV. Provider business mailing address

EVANS ARMY COMMUNITY HOSPITAL 1650 COCHRAN CIR B7500
FORT CARSON CO
80913-4263
US

V. Phone/Fax

Practice location:
  • Phone: 704-425-6878
  • Fax:
Mailing address:
  • Phone: 704-425-6878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number75295
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09929842
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: