Healthcare Provider Details

I. General information

NPI: 1871697128
Provider Name (Legal Business Name): AMBER LYNN KUTAYLI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

600 S 70TH ST
LINCOLN NE
68510-2451
US

IV. Provider business mailing address

600 S 70TH ST
LINCOLN NE
68510-2451
US

V. Phone/Fax

Practice location:
  • Phone: 402-486-7823
  • Fax: 402-486-7872
Mailing address:
  • Phone: 402-486-7823
  • Fax: 402-486-7872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number277
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: