Provider Demographics
NPI:1982900775
Name:TUPAZ, B. BRANDO (LPCC-SUPV)
Entity Type:Individual
Prefix:
First Name:B.
Middle Name:BRANDO
Last Name:TUPAZ
Suffix:
Gender:M
Credentials:LPCC-SUPV
Other - Prefix:
Other - First Name:BRANDO
Other - Middle Name:
Other - Last Name:TUPAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPCC-SUPV
Mailing Address - Street 1:6900 RIDGE RD STE 202
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44129-5650
Mailing Address - Country:US
Mailing Address - Phone:440-887-1100
Mailing Address - Fax:440-887-1103
Practice Address - Street 1:6900 RIDGE RD
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44129-5650
Practice Address - Country:US
Practice Address - Phone:408-871-1100
Practice Address - Fax:440-887-1103
Is Sole Proprietor?:No
Enumeration Date:2011-01-27
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.0003536-SUPV101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0450918Medicaid