Healthcare Provider Details

I. General information

NPI: 1093668576
Provider Name (Legal Business Name): CHRISTIAN KUNZ
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 W 100 S STE 100
LOGAN UT
84321-5840
US

IV. Provider business mailing address

566 E 1000 N APT 15
LOGAN UT
84321-2403
US

V. Phone/Fax

Practice location:
  • Phone: 385-412-9880
  • Fax:
Mailing address:
  • Phone: 208-541-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberINTERN
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: