Individual
DR. KATHLEEN MARY TUTA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
3445 YELLOWSTONE DR, ANN ARBOR, MI 48105-1503
(734) 646-9026
Mailing address
3445 YELLOWSTONE DR, ANN ARBOR, MI 48105-1503
(734) 662-8665
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301005774
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11290827
CAQH PROVIDER ID
—
01
—
680H146480
BLUE CROSS BLUE SHIELD MI
MI
Enumeration date
06/02/2006
Last updated
04/29/2019
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