Provider Demographics
NPI:1598400822
Name:LUPAS, KELLINA (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLINA
Middle Name:
Last Name:LUPAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KELLINA
Other - Middle Name:
Other - Last Name:PYLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:2800 WINSLOW AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45206-1144
Mailing Address - Country:US
Mailing Address - Phone:513-636-9792
Mailing Address - Fax:
Practice Address - Street 1:2800 WINSLOW AVE FL 4
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1144
Practice Address - Country:US
Practice Address - Phone:513-636-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-02
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10753103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent