Healthcare Provider Details

I. General information

NPI: 1528432259
Provider Name (Legal Business Name): MICHELLE KUCHMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2015
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 BERTRAND DR
LAFAYETTE LA
70506-5632
US

IV. Provider business mailing address

128 MARIETTA DR
YOUNGSVILLE LA
70592-5206
US

V. Phone/Fax

Practice location:
  • Phone: 337-261-8781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6368
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: