Provider Demographics
NPI:1932324209
Name:KUKES, KELLY RAE (MS)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:RAE
Last Name:KUKES
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 CLAPPER FLAT RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MT
Mailing Address - Zip Code:59044-9417
Mailing Address - Country:US
Mailing Address - Phone:406-628-7834
Mailing Address - Fax:
Practice Address - Street 1:15 1/2 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MT
Practice Address - Zip Code:59044-3112
Practice Address - Country:US
Practice Address - Phone:406-628-7717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1240101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT743350OtherBCBS-LEGACY