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General NPI Number Information
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NPI Number | 1861154262
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Entity Type | Organization
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Legal Business Name | LUPINE FAMILY SERVICES, LLC
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Dates
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Enumeration Date | 10/13/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 43335 KALIFORNSKI BEACH RD BLDG G
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City | SOLDOTNA
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State | AK
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Zip | 99669-8280
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Country | US
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Telephone | 907-250-1304
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Fax | 949-863-5157
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Provider Business Mailing Address
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Address Line | 520 AMES RD UNIT 2
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City | KENAI
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State | AK
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Zip | 99611-8333
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Country | US
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Telephone | 907-394-4442
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | COLLEEN SHAWNA NUSBAUM
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Credential | LCSW
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Telephone | 907-394-4442
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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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 #4
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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