Provider Demographics
NPI:1598481798
Name:LORI LUPRESTO, LMHC, LLC
Entity Type:Organization
Organization Name:LORI LUPRESTO, LMHC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LUPRESTO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:574-220-7825
Mailing Address - Street 1:18311 ABBOT CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46637-4305
Mailing Address - Country:US
Mailing Address - Phone:574-220-7825
Mailing Address - Fax:
Practice Address - Street 1:2410 GRAPE RD STE 1
Practice Address - Street 2:
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-3015
Practice Address - Country:US
Practice Address - Phone:574-243-9370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN3000051204Medicaid