Provider Demographics
NPI:1477337913
Name:LUPTON, JARED J (LPC)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:J
Last Name:LUPTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5223 W OVERLAND RD
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83705-2637
Mailing Address - Country:US
Mailing Address - Phone:208-331-4592
Mailing Address - Fax:
Practice Address - Street 1:5223 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83705-2637
Practice Address - Country:US
Practice Address - Phone:208-331-4592
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-24
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional