Provider Demographics
NPI:1629023312
Name:KUPSINEL, MORGAN MELANIE (LISW, LIMHP, IADC)
Entity Type:Individual
Prefix:MS
First Name:MORGAN
Middle Name:MELANIE
Last Name:KUPSINEL
Suffix:
Gender:F
Credentials:LISW, LIMHP, IADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6710 MASON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106
Mailing Address - Country:US
Mailing Address - Phone:402-213-7379
Mailing Address - Fax:
Practice Address - Street 1:427 E KANESVILLE BLVD
Practice Address - Street 2:SUITE 305
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-9079
Practice Address - Country:US
Practice Address - Phone:402-213-7379
Practice Address - Fax:712-248-8813
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-23
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2061101YM0800X
NE9501041C0700X
IA067851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIB1256001Medicare PIN
2273256Medicare PIN