Healthcare Provider Details

I. General information

NPI: 1346281474
Provider Name (Legal Business Name): RICH KUKA L.C.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 2ND ST S
GREAT FALLS MT
59405-4002
US

IV. Provider business mailing address

800 2ND ST S
GREAT FALLS MT
59405-4002
US

V. Phone/Fax

Practice location:
  • Phone: 406-452-4561
  • Fax: 406-452-9040
Mailing address:
  • Phone: 406-452-4561
  • Fax: 406-452-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number98
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: