Provider Demographics
NPI:1518029412
Name:KUIPER, JOHN MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:KUIPER
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 1:19090 HOLLOW LANE
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-9532
Mailing Address - Country:US
Mailing Address - Phone:530-339-0920
Mailing Address - Fax:
Practice Address - Street 1:1936 SHASTA ST
Practice Address - Street 2:A
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0407
Practice Address - Country:US
Practice Address - Phone:530-339-0920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14346103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OPL143460Medicare ID - Type Unspecified