Provider Demographics
NPI:1265667752
Name:KUIPERS, RICHIE LYNN (MCOUN)
Entity Type:Individual
Prefix:
First Name:RICHIE
Middle Name:LYNN
Last Name:KUIPERS
Suffix:
Gender:F
Credentials:MCOUN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2705 E 17TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6601
Mailing Address - Country:US
Mailing Address - Phone:208-351-9455
Mailing Address - Fax:
Practice Address - Street 1:1070 RIVERWALK DR STE 262
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83402-3343
Practice Address - Country:US
Practice Address - Phone:208-557-3507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-27
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-6281101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health