Provider Demographics
NPI:1568673424
Name:PETER H KUIPER LCSW PC
Entity Type:Organization
Organization Name:PETER H KUIPER LCSW PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:H
Authorized Official - Last Name:KUIPER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:719-395-4673
Mailing Address - Street 1:PO BOX 4767
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-4767
Mailing Address - Country:US
Mailing Address - Phone:719-395-4673
Mailing Address - Fax:719-395-6744
Practice Address - Street 1:28350 COUNTY ROAD 317
Practice Address - Street 2:SUITE #11
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211-9228
Practice Address - Country:US
Practice Address - Phone:719-395-4673
Practice Address - Fax:719-395-6744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO992582104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty