Provider Demographics
NPI:1104156058
Name:KURTYKA, JONATHAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:KURTYKA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 GOLD AVE SW
Mailing Address - Street 2:SUITE 1001
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-3228
Mailing Address - Country:US
Mailing Address - Phone:505-247-4900
Mailing Address - Fax:
Practice Address - Street 1:320 GOLD AVE SW
Practice Address - Street 2:SUITE 1001
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-3228
Practice Address - Country:US
Practice Address - Phone:505-247-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-28
Last Update Date:2011-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist