Basic Information
| Provider Information | |||||||||
| NPI: | 1538722558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KRUPINSKI | ||||||||
| FirstName: | MARTINA | ||||||||
| MiddleName: | DALE | ||||||||
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| Credential: | LPC-I | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2577 NE COURTNEY DR | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977017752 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413227500 | ||||||||
| FaxNumber: | 5413227565 | ||||||||
| Practice Location | |||||||||
| Address1: | 63311 JAMISON ST | ||||||||
| Address2: | |||||||||
| City: | BEND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 977038288 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5413227234 | ||||||||
| FaxNumber: | 5415857209 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 07/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 7116 | OK | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | C6895 | OR | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.