| Doctor Name: | DR. JEFFREY GARTH KUENTZEL |
| NPI Number: | 1073799516 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 6301011683 |
| Business Practice Address: | 383 Fisher Rd Grosse Pointe, MI - 482301674 |
| Business Phone Number: | 3136009840 |
| Business Fax Number: | 3135778949 |
| Mailing Address: | 815 N Melborn St, DEARBORN |
| State: | MI |
| Postal Code: | 481281722 |
| Phone Number: | 3136009840 |
| Fax Number: | 3135778949 |
| NPI Enumeration Date: | 01/15/2008 |
| NPI Last Update Date: | 01/15/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 6301011683 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |