Healthcare Provider Details

I. General information

NPI: 1285260026
Provider Name (Legal Business Name): CYNTHIA LEE KUIKSTRA RECOVERY COACH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2020
Last Update Date: 11/27/2023
Certification Date: 03/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E 82ND ST
NEWAYGO MI
49337-9631
US

IV. Provider business mailing address

5255 S NEWCOSTA AVE
NEWAYGO MI
49337-8227
US

V. Phone/Fax

Practice location:
  • Phone: 231-652-1780
  • Fax: 231-652-1786
Mailing address:
  • Phone: 231-937-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: