Basic Information
| Provider Information | |||||||||
| NPI: | 1659518629 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUPUIS | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | BETH | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LP, LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1727 WOODSIDE DR | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488232948 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179444232 | ||||||||
| FaxNumber: | 5179935200 | ||||||||
| Practice Location | |||||||||
| Address1: | 1905 ABBOT RD | ||||||||
| Address2: | |||||||||
| City: | EAST LANSING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 488238571 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5179444232 | ||||||||
| FaxNumber: | 5179935200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/13/2009 | ||||||||
| LastUpdateDate: | 07/24/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 6301014845 | MI | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 106H00000X | 4101006452 | MI | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.