Healthcare Provider Details

I. General information

NPI: 1851470132
Provider Name (Legal Business Name): KURT ALTIK WULFEKUHLER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CENTRAL AVE SE STE 2300
ALBUQUERQUE NM
87106-4859
US

IV. Provider business mailing address

1400 CENTRAL AVE SE STE 2300
ALBUQUERQUE NM
87106-4859
US

V. Phone/Fax

Practice location:
  • Phone: 505-255-1555
  • Fax: 505-255-1117
Mailing address:
  • Phone: 505-255-1555
  • Fax: 505-255-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number30
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number29
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: