Provider Demographics
NPI:1649760547
Name:LUPIENT, MALENA (LPC-IT)
Entity Type:Individual
Prefix:
First Name:MALENA
Middle Name:
Last Name:LUPIENT
Suffix:
Gender:F
Credentials:LPC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1504 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-2062
Mailing Address - Country:US
Mailing Address - Phone:608-632-2678
Mailing Address - Fax:
Practice Address - Street 1:115 5TH AVE S STE 507
Practice Address - Street 2:
Practice Address - City:LA CROSSE
Practice Address - State:WI
Practice Address - Zip Code:54601-4018
Practice Address - Country:US
Practice Address - Phone:608-632-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health