Provider Demographics
NPI:1154939809
Name:HUPFER, THADDEUS SCOTT (LMSW)
Entity type:Individual
Prefix:
First Name:THADDEUS
Middle Name:SCOTT
Last Name:HUPFER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714 EASTMAN AVE
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4216
Mailing Address - Country:US
Mailing Address - Phone:989-631-5390
Mailing Address - Fax:
Practice Address - Street 1:1714 EASTMAN AVE
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4216
Practice Address - Country:US
Practice Address - Phone:989-631-5390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801115036104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker