Provider Demographics
NPI:1831490044
Name:KIKUTS, KIM C (BS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:C
Last Name:KIKUTS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 DEWAR DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-6218
Mailing Address - Country:US
Mailing Address - Phone:307-382-3010
Mailing Address - Fax:307-382-6881
Practice Address - Street 1:4000 DEWAR DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-6218
Practice Address - Country:US
Practice Address - Phone:307-382-3010
Practice Address - Fax:307-382-6881
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYCAP-039101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)