Provider Demographics
NPI:1720137722
Name:LUPPE, SCOTT T (EDD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:T
Last Name:LUPPE
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5380 HOLIDAY TERRACE SUITE 25
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-2128
Mailing Address - Country:US
Mailing Address - Phone:269-353-8680
Mailing Address - Fax:
Practice Address - Street 1:5380 HOLIDAY TERRACE SUITE 25
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2128
Practice Address - Country:US
Practice Address - Phone:269-353-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301006507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OC94577OtherBCBSM
MIOC94577Medicare ID - Type Unspecified