Provider Demographics
NPI:1063454635
Name:LUPER, RHONDA MICHELLE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:MICHELLE
Last Name:LUPER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 ELDORADO PKWY STE 100-421
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-6102
Mailing Address - Country:US
Mailing Address - Phone:214-566-1020
Mailing Address - Fax:214-566-1020
Practice Address - Street 1:4100 ELDORADO PKWY STE 100-421
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-6102
Practice Address - Country:US
Practice Address - Phone:214-566-1020
Practice Address - Fax:214-566-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX339131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX609941Medicare ID - Type Unspecified
TX8F4552Medicare PIN