MEDICARE: DR. SARA BETH DUPUIS LP, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	6301014845	MI
2	106H00000X	Marriage & Family Therapist	4101006452	MI

General Provider Information

NPI Number	:	1659518629
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARA BETH DUPUIS LP, LMFT

Provider Business Mailing Address
First Line	:	1727 WOODSIDE DR
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-2948
Country	:	US
Telephone Number	:	517-944-4232
Fax Number	:	517-993-5200

Provider Business Practice Location Address
First Line	:	1905 ABBOT RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-8571
Country	:	US
Telephone Number	:	517-944-4232
Fax Number	:	517-993-5200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2009
Last Update Date	:	07/24/2013

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