Healthcare Provider Details

I. General information

NPI: 1225465941
Provider Name (Legal Business Name): JOSEPH EDWARD LUPFER SUDCC III-CS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2013
Last Update Date: 11/21/2024
Certification Date: 11/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 FORD ST
UKIAH CA
95482-4011
US

IV. Provider business mailing address

6324 E HIGHWAY 20
LUCERNE CA
95458-7801
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-1934
  • Fax:
Mailing address:
  • Phone: 707-295-2237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6134
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: