Provider Demographics
NPI:1457043853
Name:KUPP, LEA ROSE (MA, LPC)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:ROSE
Last Name:KUPP
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S ANGLE ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT JOY
Mailing Address - State:PA
Mailing Address - Zip Code:17552-2031
Mailing Address - Country:US
Mailing Address - Phone:717-653-1507
Mailing Address - Fax:
Practice Address - Street 1:410 S ANGLE ST
Practice Address - Street 2:
Practice Address - City:MOUNT JOY
Practice Address - State:PA
Practice Address - Zip Code:17552-2031
Practice Address - Country:US
Practice Address - Phone:717-653-1507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015706101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional