Provider Demographics
NPI:1306453030
Name:KUNTZ, MEGAN MARIE (INTERN LPC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:MARIE
Last Name:KUNTZ
Suffix:
Gender:F
Credentials:INTERN LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 NW HARRIMAN ST
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97703-2815
Mailing Address - Country:US
Mailing Address - Phone:541-619-5108
Mailing Address - Fax:
Practice Address - Street 1:1011 SW EMKAY DR STE 104
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97702-3162
Practice Address - Country:US
Practice Address - Phone:541-323-3477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-27
Last Update Date:2020-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health