Provider Demographics
NPI:1306203799
Name:KUTA, MICHELE RAE
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:RAE
Last Name:KUTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELE
Other - Middle Name:RAE
Other - Last Name:STEUBE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3602 16TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4164
Mailing Address - Country:US
Mailing Address - Phone:402-564-6622
Mailing Address - Fax:402-562-7239
Practice Address - Street 1:3602 16TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4164
Practice Address - Country:US
Practice Address - Phone:402-564-6622
Practice Address - Fax:402-562-7239
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health