Healthcare Provider Details

I. General information

NPI: 1336122704
Provider Name (Legal Business Name): WILLIAM H KUNTZ M.S., LCSW, LIC. PSY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/29/2025
Certification Date: 04/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 CRAIG RD STE 102C
CREVE COEUR MO
63141-7122
US

IV. Provider business mailing address

141 E MADISON AVE APT 407
KIRKWOOD MO
63122-4331
US

V. Phone/Fax

Practice location:
  • Phone: 314-712-1754
  • Fax: 314-828-5163
Mailing address:
  • Phone: 314-712-1754
  • Fax: 314-828-5163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY01685
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW002855
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: