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General NPI Number Information
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NPI Number | 1902962194
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Entity Type | Individual
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Provider Name | RAPHEAL (MONTY) E KUKA PH.D
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Gender | Male
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 920 4TH AVE N
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City | GREAT FALLS
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State | MT
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Zip | 59401-1514
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Country | US
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Telephone | 406-452-9501
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Fax | 406-727-8172
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Provider Business Mailing Address
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Address Line | 920 4TH AVE N
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City | GREAT FALLS
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State | MT
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Zip | 59401-1514
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Country | US
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Telephone | 406-452-9501
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Fax | 406-727-8172
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 66
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License Number State | MT
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