Provider Demographics
NPI:1487896874
Name:SAPP, KURT ALLAN (LMSW, MBA)
Entity type:Individual
Prefix:MR
First Name:KURT
Middle Name:ALLAN
Last Name:SAPP
Suffix:
Gender:M
Credentials:LMSW, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:MI
Mailing Address - Zip Code:49412-0149
Mailing Address - Country:US
Mailing Address - Phone:231-924-0641
Mailing Address - Fax:231-924-5594
Practice Address - Street 1:6308 S WARNER AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:MI
Practice Address - Zip Code:49412-9279
Practice Address - Country:US
Practice Address - Phone:231-924-0641
Practice Address - Fax:231-924-5594
Is Sole Proprietor?:No
Enumeration Date:2009-03-31
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010714291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical