Provider Demographics
NPI:1790793131
Name:LYNN LUPINI, PH.D., PLLC
Entity Type:Organization
Organization Name:LYNN LUPINI, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:N
Authorized Official - Last Name:LUPINI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LICENSED PSYC
Authorized Official - Phone:269-979-3881
Mailing Address - Street 1:5047 W MAIN ST # 317
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-1001
Mailing Address - Country:US
Mailing Address - Phone:269-979-3881
Mailing Address - Fax:269-979-2841
Practice Address - Street 1:309 W WALNUT ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5176
Practice Address - Country:US
Practice Address - Phone:269-274-8003
Practice Address - Fax:269-979-2841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011489103T00000X
261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIMI9118Medicaid
MI0P11970OtherMEDICARE PTAN