Provider Demographics
NPI:1124549514
Name:LUPPINO, GENNY LYNN (LPC)
Entity Type:Individual
Prefix:MS
First Name:GENNY
Middle Name:LYNN
Last Name:LUPPINO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 W JEFFERSON AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48183-2706
Mailing Address - Country:US
Mailing Address - Phone:734-365-6976
Mailing Address - Fax:734-283-7287
Practice Address - Street 1:2360 W JEFFERSON AVE STE 102
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2706
Practice Address - Country:US
Practice Address - Phone:734-365-6976
Practice Address - Fax:734-283-7287
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015177101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor