Healthcare Provider Details

I. General information

NPI: 1326010851
Provider Name (Legal Business Name): CAROL BETTY KUNTZ PYS.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2006
Last Update Date: 12/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4400 W 69TH ST STE 1500
SIOUX FALLS SD
57108-8170
US

IV. Provider business mailing address

PO BOX 86370
SIOUX FALLS SD
57118-6370
US

V. Phone/Fax

Practice location:
  • Phone: 605-322-5700
  • Fax: 605-322-5704
Mailing address:
  • Phone: 605-322-7510
  • Fax: 605-322-6475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number348
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: