Healthcare Provider Details

I. General information

NPI: 1225983760
Provider Name (Legal Business Name): MKB THERAPY, MKB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2026
Last Update Date: 03/02/2026
Certification Date: 03/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1209 MOUNTAIN ROAD PL NE STE R
ALBUQUERQUE NM
87110-7845
US

IV. Provider business mailing address

3673 IRONWOOD DR
ALAMOGORDO NM
88310-5485
US

V. Phone/Fax

Practice location:
  • Phone: 505-456-4212
  • Fax:
Mailing address:
  • Phone: 575-415-5612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MARYLOUISE TINEKE KUTI
Title or Position: OWNER/LEAD THERAPIST
Credential: LCSW
Phone: 575-415-5612