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General NPI Number Information
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NPI Number | 1386025096
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Entity Type | Organization
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Legal Business Name | JOHN G KUTINAC, INC
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Dates
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Enumeration Date | 06/18/2015
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Last Update Date | 06/18/2015
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Provider Practice Location Address
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Address Line | 1155 S TELSHOR BLVD SUITE 200
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City | LAS CRUCES
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State | NM
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Zip | 88011-1009
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Country | US
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Telephone | 575-522-8002
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Fax | 575-522-8027
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Provider Business Mailing Address
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Address Line | 1155 S TELSHOR BLVD SUITE 200
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City | LAS CRUCES
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State | NM
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Zip | 88011-1009
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Country | US
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Telephone | 575-522-8002
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Fax | 575-522-8027
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Authorized Official
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Title or Position | OWNER
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Name | JOHN G KUTINAC JR.
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Credential | MA PA LPCC
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Telephone | 575-522-8002
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PA9501
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License Number State | NM
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