Healthcare Provider Details

I. General information

NPI: 1508844135
Provider Name (Legal Business Name): JOHN G KUTINAC JR. MA PA LPCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 S TELSHOR BLVD STE 200
LAS CRUCES NM
88011-1009
US

IV. Provider business mailing address

1155 S TELSHOR BLVD STE 200
LAS CRUCES NM
88011-1009
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-8002
  • Fax: 505-522-8027
Mailing address:
  • Phone: 505-522-8002
  • Fax: 505-522-8027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPA9501
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1157
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: