Provider Demographics
NPI:1659687846
Name:HOUPPERT, LORI A (LMHC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:HOUPPERT
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:A
Other - Last Name:TIFFANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:3532 MECHANIC ST
Mailing Address - Street 2:
Mailing Address - City:PORT LEYDEN
Mailing Address - State:NY
Mailing Address - Zip Code:13433-1805
Mailing Address - Country:US
Mailing Address - Phone:315-507-1802
Mailing Address - Fax:
Practice Address - Street 1:3532 MECHANIC ST
Practice Address - Street 2:
Practice Address - City:PORT LEYDEN
Practice Address - State:NY
Practice Address - Zip Code:13433-1805
Practice Address - Country:US
Practice Address - Phone:315-507-1802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004560-01101YM0800X
NY004560101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health