Provider Demographics
NPI:1104254051
Name:SARA B DUPUIS PHD PC
Entity type:Organization
Organization Name:SARA B DUPUIS PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER BILLING
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GALLEGOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:517-483-2461
Mailing Address - Street 1:1905 ABBOT RD
Mailing Address - Street 2:STE 1
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-8571
Mailing Address - Country:US
Mailing Address - Phone:517-944-4232
Mailing Address - Fax:517-323-9531
Practice Address - Street 1:1905 ABBOT RD
Practice Address - Street 2:STE 1
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-8571
Practice Address - Country:US
Practice Address - Phone:517-944-4232
Practice Address - Fax:517-323-9531
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-30
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014845103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty