Healthcare Provider Details

I. General information

NPI: 1164027066
Provider Name (Legal Business Name): JUNE KUIPER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/01/2020
Last Update Date: 05/18/2023
Certification Date: 12/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 E BELTLINE AVE NE STE 100
GRAND RAPIDS MI
49506-1214
US

IV. Provider business mailing address

333 BRIDGE ST NW STE 1120
GRAND RAPIDS MI
49504-5356
US

V. Phone/Fax

Practice location:
  • Phone: 616-805-3660
  • Fax:
Mailing address:
  • Phone: 616-805-3660
  • Fax: 616-805-3631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6401018170
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401223421
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: