Provider Demographics
NPI:1871983072
Name:CUPP, KAREN (MS TLLP)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:CUPP
Suffix:
Gender:F
Credentials:MS TLLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21825 WOODRUFF RD
Mailing Address - Street 2:APT G3
Mailing Address - City:ROCKWOOD
Mailing Address - State:MI
Mailing Address - Zip Code:48173-1062
Mailing Address - Country:US
Mailing Address - Phone:313-600-3395
Mailing Address - Fax:
Practice Address - Street 1:21825 WOODRUFF RD
Practice Address - Street 2:APT G3
Practice Address - City:ROCKWOOD
Practice Address - State:MI
Practice Address - Zip Code:48173-1062
Practice Address - Country:US
Practice Address - Phone:313-600-3395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008378103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling