Healthcare Provider Details

I. General information

NPI: 1265665970
Provider Name (Legal Business Name): MICAH JOHN KURTZ LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2009
Last Update Date: 06/28/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11234 TAYLOR PL
GIG HARBOR WA
98332-7916
US

IV. Provider business mailing address

11234 TAYLOR PL
GIG HARBOR WA
98332-7916
US

V. Phone/Fax

Practice location:
  • Phone: 425-429-2201
  • Fax:
Mailing address:
  • Phone: 425-429-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61312360
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: