Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1992993901 |
---|---|
Provider Name | Kevonn Tutt |
First Address | Louisville, KY 40202-1423 |
Second Address | Louisville, KY 40204-1037 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2007 |
Last Update Date | 04/10/2007 |