Healthcare Provider Details

I. General information

NPI: 1629090667
Provider Name (Legal Business Name): KEVIN M RUTTER MS, LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 FAIRGROVE CHURCH RD SE STE 202
CONOVER NC
28613-9289
US

IV. Provider business mailing address

715 FAIRGROVE CHURCH RD SE STE 202
CONOVER NC
28613-9289
US

V. Phone/Fax

Practice location:
  • Phone: 828-638-5907
  • Fax: 828-322-2280
Mailing address:
  • Phone: 828-638-5907
  • Fax: 828-322-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number851
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number851
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: