Healthcare Provider Details

I. General information

NPI: 1063714483
Provider Name (Legal Business Name): ADRIAN KUPPER BAURES MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2010
Last Update Date: 11/18/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 S UNIVERSITY AVE SUITE 1400
PROVO UT
84601-4427
US

IV. Provider business mailing address

151 S UNIVERSITY AVE SUITE 1400
PROVO UT
84601-4427
US

V. Phone/Fax

Practice location:
  • Phone: 801-851-7127
  • Fax: 801-851-7186
Mailing address:
  • Phone: 801-851-7127
  • Fax: 801-851-7186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number61066073904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: