Provider Demographics
NPI:1649692948
Name:KUFFEL, MICHAEL P (MA, LCPC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:KUFFEL
Suffix:
Gender:M
Credentials:MA, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 W MAIN ST STE 370
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-6165
Mailing Address - Country:US
Mailing Address - Phone:208-285-4289
Mailing Address - Fax:
Practice Address - Street 1:1109 W MAIN ST STE 370
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-6165
Practice Address - Country:US
Practice Address - Phone:208-285-4289
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-07
Last Update Date:2022-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH-60640951101YM0800X
IDLCPC-7348101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health