Provider Demographics
NPI:1255458824
Name:CZUPRENSKI, KATHLEEN A
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:CZUPRENSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13443 HAUPT DR
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48088-6922
Mailing Address - Country:US
Mailing Address - Phone:586-477-4067
Mailing Address - Fax:586-493-0740
Practice Address - Street 1:275 N GROESBECK HWY
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-1546
Practice Address - Country:US
Practice Address - Phone:586-477-4067
Practice Address - Fax:586-493-0740
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704153841101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health