Healthcare Provider Details

I. General information

NPI: 1659817575
Provider Name (Legal Business Name): KEVIN RAY KURTZ LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 01/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 FALLS RD.
TOCCOA GA
30577
US

IV. Provider business mailing address

PO BX 1634
TOCCOA GA
30577
US

V. Phone/Fax

Practice location:
  • Phone: 706-491-7064
  • Fax: 706-886-6599
Mailing address:
  • Phone: 706-491-7064
  • Fax: 706-886-6599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number02131595
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC009304
License Number StateGA

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: