Healthcare Provider Details

I. General information

NPI: 1063223352
Provider Name (Legal Business Name): AMY KUTSCHBACH MRC, CRC, CVE, CCM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5403 MARTIN CV
BOKEELIA FL
33922-3030
US

IV. Provider business mailing address

5403 MARTIN CV
BOKEELIA FL
33922-3030
US

V. Phone/Fax

Practice location:
  • Phone: 833-287-8733
  • Fax: 833-287-8733
Mailing address:
  • Phone: 833-287-8733
  • Fax: 833-287-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: