Healthcare Provider Details

I. General information

NPI: 1932324209
Provider Name (Legal Business Name): KELLY RAE KUKES M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 1/2 COLORADO AVE
LAUREL MT
59044-3151
US

IV. Provider business mailing address

2900 CLAPPER FLAT RD
LAUREL MT
59044-9417
US

V. Phone/Fax

Practice location:
  • Phone: 406-628-7717
  • Fax:
Mailing address:
  • Phone: 406-690-2870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1240
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1240
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: