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General NPI Number Information
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NPI Number | 1760243851
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Entity Type | Organization
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Legal Business Name | TAMRA M KRUTZ MA LPC PA
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Dates
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Enumeration Date | 01/17/2024
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 708 W SUPERIOR ST STE B
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City | SANDPOINT
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State | ID
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Zip | 83864-1633
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Country | US
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Telephone | 208-265-3579
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Fax | 208-204-0182
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Provider Business Mailing Address
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Address Line | 708 W SUPERIOR ST STE B
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City | SANDPOINT
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State | ID
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Zip | 83864-1633
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Country | US
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Telephone | 208-265-3579
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Fax | 208-204-0182
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Authorized Official
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Title or Position | PRESIDENT
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Name | TAMRA M KRUTZ
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Credential | MA, LCPC, PA
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Telephone | 208-265-3579
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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