Healthcare Provider Details

I. General information

NPI: 1477910008
Provider Name (Legal Business Name): LAURA LEE KUIPERS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2016
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 HOLTON RD
MUSKEGON MI
49445-1675
US

IV. Provider business mailing address

2330 HOLTON RD
MUSKEGON MI
49445-1675
US

V. Phone/Fax

Practice location:
  • Phone: 231-730-3239
  • Fax:
Mailing address:
  • Phone: 231-730-3239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401011970
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: