Provider Demographics
NPI:1598039901
Name:CUPP, JARRETT STEVEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:JARRETT
Middle Name:STEVEN
Last Name:CUPP
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 1:677 E. MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032
Mailing Address - Country:US
Mailing Address - Phone:269-467-1921
Mailing Address - Fax:269-979-7766
Practice Address - Street 1:677 E. MAIN ST.
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032
Practice Address - Country:US
Practice Address - Phone:269-467-1921
Practice Address - Fax:269-979-7766
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401018917101YP2500X
MI6401014320101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6301015049OtherLICENSE #