Provider Demographics
NPI:1821552472
Name:SHUPE, EMILYANN ROSE (MSCP, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:EMILYANN
Middle Name:ROSE
Last Name:SHUPE
Suffix:
Gender:F
Credentials:MSCP, LMFT
Other - Prefix:MISS
Other - First Name:EMILYANN
Other - Middle Name:ROSE
Other - Last Name:NIERENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 UNIVERSITY AVE APT 701
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-5008
Mailing Address - Country:US
Mailing Address - Phone:818-219-8209
Mailing Address - Fax:
Practice Address - Street 1:438 HOBRON LN STE 405
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96815-1229
Practice Address - Country:US
Practice Address - Phone:808-941-9648
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI548106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist