Provider Demographics
NPI:1295036119
Name:CUPPETT, BARBARA B (MA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:B
Last Name:CUPPETT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 QUANTRELLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-0139
Mailing Address - Country:US
Mailing Address - Phone:763-633-3800
Mailing Address - Fax:763-633-3808
Practice Address - Street 1:9000 QUANTRELLE AVE NE
Practice Address - Street 2:
Practice Address - City:OTSEGO
Practice Address - State:MN
Practice Address - Zip Code:55330-0139
Practice Address - Country:US
Practice Address - Phone:763-633-3800
Practice Address - Fax:763-633-3808
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2017-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL166000641106H00000X
MN3522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist