Provider Demographics
NPI:1043316722
Name:SHUPTRINE, JULIE ANN (LISW)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:ANN
Last Name:SHUPTRINE
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43209-2056
Mailing Address - Country:US
Mailing Address - Phone:614-578-9644
Mailing Address - Fax:614-358-1122
Practice Address - Street 1:52 W 5TH AVE
Practice Address - Street 2:STE A
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43201-7200
Practice Address - Country:US
Practice Address - Phone:614-578-9644
Practice Address - Fax:614-358-1122
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00078481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical