Provider Demographics
NPI:1760375323
Name:KUPER, KEVIN (BA, R-AAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:KUPER
Suffix:
Gender:M
Credentials:BA, R-AAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2394
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-8455
Mailing Address - Country:US
Mailing Address - Phone:360-200-5419
Mailing Address - Fax:844-612-6673
Practice Address - Street 1:1340 12TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3820
Practice Address - Country:US
Practice Address - Phone:360-200-5419
Practice Address - Fax:844-612-6673
Is Sole Proprietor?:No
Enumeration Date:2025-06-02
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61672117101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor