Healthcare Provider Details

I. General information

NPI: 1013681147
Provider Name (Legal Business Name): DEREK KUIPER LMHCA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2021
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 NE 97TH ST STE A
SEATTLE WA
98115-2042
US

IV. Provider business mailing address

748 MARKET ST UNIT 54
TACOMA WA
98402-3737
US

V. Phone/Fax

Practice location:
  • Phone: 512-786-6178
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLH61249974
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: