Healthcare Provider Details

I. General information

NPI: 1326272816
Provider Name (Legal Business Name): STEVEN BRANT KUTASH PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 02/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 CENTRE AVE SUITE B
FORT COLLINS CO
80526-1849
US

IV. Provider business mailing address

1030 CENTRE AVE SUITE B
FORT COLLINS CO
80526-1849
US

V. Phone/Fax

Practice location:
  • Phone: 970-568-6323
  • Fax: 970-305-8322
Mailing address:
  • Phone: 970-568-6323
  • Fax: 970-305-8322

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25921
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY.0004112
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: