Organization
LUPINE FAMILY SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
COLLEEN SHAWNA NUSBAUM LCSW (DIRECTOR)
(907) 394-4442
Entity
Organization
Contact information
Practice address
43335 KALIFORNSKI BEACH RD BLDG G, SOLDOTNA, AK 99669-8280
(907) 250-1304
(949) 863-5157
Mailing address
520 AMES RD UNIT 2, KENAI, AK 99611-8333
(907) 394-4442
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
Primary
—
—
171M00000X
Case Manager/Care Coordinator
—
—
225700000X
Massage Therapist
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QM0855X
Adolescent and Children Mental Health Clinic/Center
—
—
Other
Enumeration date
10/13/2021
Last updated
10/26/2021
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