Healthcare Provider Details

I. General information

NPI: 1477056075
Provider Name (Legal Business Name): LISA KUIPER LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 03/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16325 HARLEM AVE STE 200
TINLEY PARK IL
60477-1688
US

IV. Provider business mailing address

320 61ST ST
DOWNERS GROVE IL
60516-2029
US

V. Phone/Fax

Practice location:
  • Phone: 708-429-6999
  • Fax:
Mailing address:
  • Phone: 312-352-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.011515
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: