Provider Demographics
NPI:1336122704
Name:KUNTZ, WILLIAM H (MS, LCSW, LIC PSY)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:H
Last Name:KUNTZ
Suffix:
Gender:
Credentials:MS, LCSW, LIC PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 E MADISON AVE APT 407
Mailing Address - Street 2:
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122-4331
Mailing Address - Country:US
Mailing Address - Phone:314-712-1754
Mailing Address - Fax:314-828-5163
Practice Address - Street 1:745 CRAIG RD STE 102C
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7122
Practice Address - Country:US
Practice Address - Phone:314-712-1754
Practice Address - Fax:314-828-5163
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOSW0028551041C0700X
MOPY01685103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496729708Medicaid
MO496729708Medicaid