Provider Demographics
NPI:1851769202
Name:KIPER, GREG (MA, LMHCA, CDP)
Entity Type:Individual
Prefix:
First Name:GREG
Middle Name:
Last Name:KIPER
Suffix:
Gender:M
Credentials:MA, LMHCA, CDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MOORE DR
Mailing Address - Street 2:
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-6342
Mailing Address - Country:US
Mailing Address - Phone:425-888-6551
Mailing Address - Fax:425-888-6727
Practice Address - Street 1:100 MOORE DR
Practice Address - Street 2:
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-6342
Practice Address - Country:US
Practice Address - Phone:425-888-6551
Practice Address - Fax:425-888-6727
Is Sole Proprietor?:No
Enumeration Date:2015-09-02
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
WACP60682694101YA0400X
WAMC 60675660101YM0800X
AZLPC-21084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2074701Medicaid