Provider Demographics
NPI:1902962194
Name:KUKA, RAPHEAL (MONTY) E (PHD)
Entity Type:Individual
Prefix:DR
First Name:RAPHEAL (MONTY)
Middle Name:E
Last Name:KUKA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 4TH AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1514
Mailing Address - Country:US
Mailing Address - Phone:406-452-9501
Mailing Address - Fax:406-727-8172
Practice Address - Street 1:920 4TH AVE N
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-1514
Practice Address - Country:US
Practice Address - Phone:406-452-9501
Practice Address - Fax:406-727-8172
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT66103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist