Provider Demographics
NPI:1689451288
Name:KRUPA, KAI LACEY KING
Entity Type:Individual
Prefix:
First Name:KAI
Middle Name:LACEY KING
Last Name:KRUPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 E GUIBERSON RD
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-9785
Mailing Address - Country:US
Mailing Address - Phone:206-735-6908
Mailing Address - Fax:
Practice Address - Street 1:30 W MISSION ST STE 7
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-0404
Practice Address - Country:US
Practice Address - Phone:206-735-6908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health