Healthcare Provider Details

I. General information

NPI: 1407366800
Provider Name (Legal Business Name): JOANN KUTSUKOS LMHC, CAP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/11/2017
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 SE FEDERAL HWY STE 105
STUART FL
34994-3409
US

IV. Provider business mailing address

755 SATURN STREET E207
JUPITER FL
33477
US

V. Phone/Fax

Practice location:
  • Phone: 772-444-7388
  • Fax: 772-444-7388
Mailing address:
  • Phone: 561-379-7338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMH11706
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: