Healthcare Provider Details

I. General information

NPI: 1043872021
Provider Name (Legal Business Name): TAMARA LOPUSINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2019
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 NURSERY RD APT 8-104
CLEARWATER FL
33764-7674
US

IV. Provider business mailing address

2225 NURSERY RD APT 8-104
CLEARWATER FL
33764-7674
US

V. Phone/Fax

Practice location:
  • Phone: 763-670-5877
  • Fax:
Mailing address:
  • Phone: 763-670-5877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: