1770802241 NPI number — PAUL L. KURTZWEIL, PH.D. LLC

Table of content: (NPI 1770802241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770802241 NPI number — PAUL L. KURTZWEIL, PH.D. LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAUL L. KURTZWEIL, PH.D. LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770802241
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9415 E HARRY ST STE 204
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67207-5076
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-200-5391
Provider Business Mailing Address Fax Number:
316-618-9291

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9415 E HARRY ST STE 204
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67207-5076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-200-5391
Provider Business Practice Location Address Fax Number:
316-618-9291
Provider Enumeration Date:
05/24/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KURTZWEIL
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
LOVEJOY
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
316-200-5391

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  LP-0935 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)