Healthcare Provider Details

I. General information

NPI: 1376000604
Provider Name (Legal Business Name): KUCHTA COUNSELING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2019
Last Update Date: 02/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

814 GRACE AVE
PANAMA CITY FL
32401-2520
US

IV. Provider business mailing address

PO BOX 1234
PANAMA CITY FL
32402-1234
US

V. Phone/Fax

Practice location:
  • Phone: 850-358-8389
  • Fax: 850-541-9914
Mailing address:
  • Phone: 850-358-8389
  • Fax: 850-541-9914

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: ROBERT MATTHEW KUCHTA
Title or Position: OWNER
Credential: LCSW
Phone: 850-358-8389