Provider Demographics
NPI:1457574972
Name:KUPFER MEARES, KIM RUTH (MFT)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:RUTH
Last Name:KUPFER MEARES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MRS
Other - First Name:KIM
Other - Middle Name:RUTH
Other - Last Name:KUPFER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MFT
Mailing Address - Street 1:PO BOX 954
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352
Mailing Address - Country:US
Mailing Address - Phone:909-383-7100
Mailing Address - Fax:909-890-0244
Practice Address - Street 1:27299 HOSPITAL ROAD
Practice Address - Street 2:SUITE 107
Practice Address - City:LAKE ARROWHEAD
Practice Address - State:CA
Practice Address - Zip Code:92352
Practice Address - Country:US
Practice Address - Phone:909-383-7100
Practice Address - Fax:909-890-0244
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC21299106H00000X
CAMFC27299106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist