Provider Demographics
NPI:1336947605
Name:SHUPE, AMBERLI KYRA (MA, NCC)
Entity type:Individual
Prefix:
First Name:AMBERLI
Middle Name:KYRA
Last Name:SHUPE
Suffix:
Gender:
Credentials:MA, NCC
Other - Prefix:
Other - First Name:AMBERLI
Other - Middle Name:KYRA
Other - Last Name:CLINEBELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:207 E MAIN ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-5749
Mailing Address - Country:US
Mailing Address - Phone:423-430-9362
Mailing Address - Fax:423-830-0767
Practice Address - Street 1:207 E MAIN ST STE 2E
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-5749
Practice Address - Country:US
Practice Address - Phone:423-430-9362
Practice Address - Fax:423-830-0767
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health