Provider Demographics
NPI:1124399050
Name:DUPUIS, JODIE S (MA LMHCA LPC)
Entity Type:Individual
Prefix:
First Name:JODIE
Middle Name:S
Last Name:DUPUIS
Suffix:
Gender:F
Credentials:MA LMHCA LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 W ALDER ST STE 335
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2863
Mailing Address - Country:US
Mailing Address - Phone:509-557-0664
Mailing Address - Fax:
Practice Address - Street 1:5 W ALDER ST STE 335
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2863
Practice Address - Country:US
Practice Address - Phone:509-557-0664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-24
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171M00000X
WAMC61009451101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator