Provider Demographics
NPI:1477561884
Name:LUPINI, LYNN NYLUND (PHD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:NYLUND
Last Name:LUPINI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5047 W MAIN ST # 317
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1001
Mailing Address - Country:US
Mailing Address - Phone:269-979-3881
Mailing Address - Fax:269-979-2841
Practice Address - Street 1:309 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5176
Practice Address - Country:US
Practice Address - Phone:269-979-3881
Practice Address - Fax:269-979-3881
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011489103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP11970001OtherMEDICARE PTAN