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General NPI Number Information
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NPI Number | 1073799516
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Entity Type | Individual
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Provider Name | JEFFREY GARTH KUENTZEL PH.D.
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Gender | Male
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Dates
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Enumeration Date | 01/15/2008
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 383 FISHER RD
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1674
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Country | US
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Telephone | 313-600-9840
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Fax | 313-577-8949
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Provider Business Mailing Address
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Address Line | 815 N MELBORN ST
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City | DEARBORN
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State | MI
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Zip | 48128-1722
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Country | US
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Telephone | 313-600-9840
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Fax | 313-577-8949
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 6301011683
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License Number State | MI
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