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General NPI Number Information
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NPI Number | 1225465941
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Entity Type | Individual
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Provider Name | JOSEPH EDWARD LUPFER SUDCC III-CS
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Gender | Male
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Dates
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Enumeration Date | 09/27/2013
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Last Update Date | 11/21/2024
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Provider Practice Location Address
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Address Line | 139 FORD ST
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City | UKIAH
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State | CA
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Zip | 95482-4011
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Country | US
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Telephone | 707-462-1934
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Fax |
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Provider Business Mailing Address
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Address Line | 6324 E HIGHWAY 20
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City | LUCERNE
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State | CA
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Zip | 95458-7801
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Country | US
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Telephone | 707-295-2237
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 6134
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License Number State | CA
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