Provider Demographics
NPI:1215284229
Name:KUNZI, KARL (LPC, ACS, SST)
Entity type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:KUNZI
Suffix:
Gender:M
Credentials:LPC, ACS, SST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 FORT WADE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA
Mailing Address - State:FL
Mailing Address - Zip Code:32081-5114
Mailing Address - Country:US
Mailing Address - Phone:734-720-9782
Mailing Address - Fax:734-571-6888
Practice Address - Street 1:90 FORT WADE RD STE 100
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA
Practice Address - State:FL
Practice Address - Zip Code:32081-5114
Practice Address - Country:US
Practice Address - Phone:734-720-9782
Practice Address - Fax:734-571-6888
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012410101YP2500X
FLMH23182101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional