Healthcare Provider Details

I. General information

NPI: 1598378911
Provider Name (Legal Business Name): SEAN NIKOLAS KUYPER MA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: NIKO KUYPER MA

II. Dates (important events)

Enumeration Date: 08/25/2020
Last Update Date: 08/25/2020
Certification Date: 08/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

353 PARK MARINA CIR
REDDING CA
96001-0965
US

IV. Provider business mailing address

15570 BROOK DR
REDDING CA
96001-8702
US

V. Phone/Fax

Practice location:
  • Phone: 530-356-9793
  • Fax:
Mailing address:
  • Phone: 530-356-9793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: