Provider Demographics
NPI:1871781880
Name:RUPP-HUNT, PATRICIA (LISW-S)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:RUPP-HUNT
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15830 SCHOOLHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45309-9716
Mailing Address - Country:US
Mailing Address - Phone:937-750-7877
Mailing Address - Fax:937-660-3653
Practice Address - Street 1:15830 SCHOOLHOUSE RD
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:OH
Practice Address - Zip Code:45309-9716
Practice Address - Country:US
Practice Address - Phone:937-750-7877
Practice Address - Fax:937-660-3653
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI 0800208104100000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHI 0800208Medicaid
OHI 0800208Medicare PIN