Provider Demographics
NPI:1689005084
Name:KUPOR, ELANA (LMHC)
Entity Type:Individual
Prefix:
First Name:ELANA
Middle Name:
Last Name:KUPOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3937 SW MONROE ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98136-2334
Mailing Address - Country:US
Mailing Address - Phone:206-659-2321
Mailing Address - Fax:
Practice Address - Street 1:1900 N NORTHLAKE WAY
Practice Address - Street 2:SUITE 127
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98103-9051
Practice Address - Country:US
Practice Address - Phone:206-659-2321
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60210915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health