Provider Demographics
NPI:1275899098
Name:KYPTA, BRIAN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:KYPTA
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 FANTAGES WAY
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-8145
Mailing Address - Country:US
Mailing Address - Phone:916-850-5084
Mailing Address - Fax:
Practice Address - Street 1:4995 GOLDEN FOOTHILL PKWY
Practice Address - Street 2:SUITE 2
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-9645
Practice Address - Country:US
Practice Address - Phone:916-850-5084
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-05
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82219106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist