Healthcare Provider Details

I. General information

NPI: 1518029412
Provider Name (Legal Business Name): JOHN MICHAEL KUIPER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1936 SHASTA ST A
REDDING CA
96001-0407
US

IV. Provider business mailing address

19090 HOLLOW LANE
REDDING CA
96003-9532
US

V. Phone/Fax

Practice location:
  • Phone: 530-339-0920
  • Fax:
Mailing address:
  • Phone: 530-339-0920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY14346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: