Provider Demographics
NPI:1013527134
Name:BUPP, LINDSEY L (PHD)
Entity Type:Individual
Prefix:
First Name:LINDSEY
Middle Name:L
Last Name:BUPP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 N ALTADENA AVE
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-3555
Mailing Address - Country:US
Mailing Address - Phone:520-241-4044
Mailing Address - Fax:
Practice Address - Street 1:3007 N ALTADENA AVE
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-3555
Practice Address - Country:US
Practice Address - Phone:520-241-4044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-04
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301018203103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical