Provider Demographics
NPI:1285742114
Name:KURTIN, CLOUD K (LBSW)
Entity type:Individual
Prefix:MR
First Name:CLOUD
Middle Name:K
Last Name:KURTIN
Suffix:
Gender:M
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 RENZEL BLVD
Mailing Address - Street 2:#352
Mailing Address - City:FT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116
Mailing Address - Country:US
Mailing Address - Phone:817-995-7434
Mailing Address - Fax:
Practice Address - Street 1:2516 OAKLAND BLVD
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103
Practice Address - Country:US
Practice Address - Phone:817-429-2290
Practice Address - Fax:817-451-8114
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25913101YM0800X
VT25913101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional