Provider Demographics
NPI:1093170094
Name:CUDDEBACK, MILINDA KAYE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MILINDA
Middle Name:KAYE
Last Name:CUDDEBACK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 S CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2344
Mailing Address - Country:US
Mailing Address - Phone:231-775-6517
Mailing Address - Fax:
Practice Address - Street 1:805 S CARMEL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2344
Practice Address - Country:US
Practice Address - Phone:231-775-6517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-18
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401013006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11004983923OtherGROUP NPI
MI0M27300Medicare UPIN