Healthcare Provider Details

I. General information

NPI: 1992648760
Provider Name (Legal Business Name): MICHELLE RUPP LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2026
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51424 VAN DYKE AVE STE 23
SHELBY TOWNSHIP MI
48316-4409
US

IV. Provider business mailing address

5618 KINGFISHER LN
CLARKSTON MI
48346-2937
US

V. Phone/Fax

Practice location:
  • Phone: 586-215-6534
  • Fax: 586-218-3158
Mailing address:
  • Phone: 248-229-6186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401008638
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: