Provider Demographics
NPI:1598378911
Name:KUYPER, SEAN NIKOLAS (MA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:NIKOLAS
Last Name:KUYPER
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:NIKO
Other - Middle Name:
Other - Last Name:KUYPER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:15570 BROOK DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-8702
Mailing Address - Country:US
Mailing Address - Phone:530-356-9793
Mailing Address - Fax:
Practice Address - Street 1:353 PARK MARINA CIR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-0965
Practice Address - Country:US
Practice Address - Phone:530-356-9793
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist