Healthcare Provider Details

I. General information

NPI: 1184997009
Provider Name (Legal Business Name): MAJA CUPAC LPCC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2012
Last Update Date: 09/15/2021
Certification Date: 09/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MARKET ST
LOUISVILLE KY
40206-1838
US

IV. Provider business mailing address

926 WILLOW POINTE DR
LOUISVILLE KY
40299-6604
US

V. Phone/Fax

Practice location:
  • Phone: 502-596-1213
  • Fax: 502-596-1400
Mailing address:
  • Phone: 606-219-2380
  • Fax: 502-331-6062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberKY-1116
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: