Healthcare Provider Details

I. General information

NPI: 1629405196
Provider Name (Legal Business Name): ANGELA ROSE KUNTZ MSC, LAPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 09/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E MAIN AVE SUITE #301
BISMARCK ND
58501-3857
US

IV. Provider business mailing address

PO BOX 5501
BISMARCK ND
58506-5501
US

V. Phone/Fax

Practice location:
  • Phone: 701-323-5626
  • Fax:
Mailing address:
  • Phone: 701-323-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number754-6-15-13A
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: