Provider Demographics
NPI:1982018578
Name:PUGH, KURTIS JAMES (LPC)
Entity type:Individual
Prefix:
First Name:KURTIS
Middle Name:JAMES
Last Name:PUGH
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16848 CHAMBERS WAY
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:ID
Mailing Address - Zip Code:83607-5518
Mailing Address - Country:US
Mailing Address - Phone:719-369-6063
Mailing Address - Fax:801-373-0639
Practice Address - Street 1:124 MCCLURE AVE
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-2025
Practice Address - Country:US
Practice Address - Phone:719-369-6063
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-11
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID6461673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional