Provider Demographics
NPI:1033530886
Name:RUPE, SALLIE LYNN (MFT INTERN)
Entity Type:Individual
Prefix:MS
First Name:SALLIE
Middle Name:LYNN
Last Name:RUPE
Suffix:
Gender:F
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MOORPARK AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4449
Mailing Address - Country:US
Mailing Address - Phone:408-975-2730
Mailing Address - Fax:408-975-2745
Practice Address - Street 1:2400 MOORPARK AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2680
Practice Address - Country:US
Practice Address - Phone:408-975-2730
Practice Address - Fax:408-975-2745
Is Sole Proprietor?:No
Enumeration Date:2013-12-20
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA85345106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist