Healthcare Provider Details

I. General information

NPI: 1811398092
Provider Name (Legal Business Name): KELLA KUTTER MA, MFT, CADC-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2014
Last Update Date: 03/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9492 DOUBLE R BLVD SUITE C
RENO NV
89521-6024
US

IV. Provider business mailing address

9492 DOUBLE R BLVD SUITE C
RENO NV
89521-6024
US

V. Phone/Fax

Practice location:
  • Phone: 775-544-8248
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number01411
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: