Healthcare Provider Details

I. General information

NPI: 1790793131
Provider Name (Legal Business Name): LYNN LUPINI, PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 11/28/2022
Certification Date: 11/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 W WALNUT ST
KALAMAZOO MI
49007-5176
US

IV. Provider business mailing address

5047 W MAIN ST # 317
KALAMAZOO MI
49009-1001
US

V. Phone/Fax

Practice location:
  • Phone: 269-274-8003
  • Fax: 269-979-2841
Mailing address:
  • Phone: 269-979-3881
  • Fax: 269-979-2841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6301011489
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LYNN N. LUPINI
Title or Position: OWNER
Credential: PH.D., LICENSED PSYC
Phone: 269-979-3881