Provider Demographics
NPI:1700938768
Name:HUPP, GARY A (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:HUPP
Suffix:
Gender:M
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:775 SUNRISE AVE
Mailing Address - Street 2:SUITE NUMBER 140
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4523
Mailing Address - Country:US
Mailing Address - Phone:916-784-1244
Mailing Address - Fax:916-784-3949
Practice Address - Street 1:775 SUNRISE AVE
Practice Address - Street 2:SUITE NUMBER 140
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4523
Practice Address - Country:US
Practice Address - Phone:916-784-1244
Practice Address - Fax:916-784-3949
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS10424101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health