Provider Demographics
NPI:1871782243
Name:KUTY, JEAN MARIE (LCPC)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:MARIE
Last Name:KUTY
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7514 N PEPPERMILL WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83714-2158
Mailing Address - Country:US
Mailing Address - Phone:208-353-6151
Mailing Address - Fax:
Practice Address - Street 1:7514 N PEPPERMILL WAY
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83714-2158
Practice Address - Country:US
Practice Address - Phone:208-353-6151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3874101YM0800X
IDLCPC4891101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health