Healthcare Provider Details

I. General information

NPI: 1750524021
Provider Name (Legal Business Name): CHRISTINE M STUPAVSKY LPC, LCPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2314 MELVIEW RD
QUINCY IL
62305-2724
US

IV. Provider business mailing address

2314 MELVIEW RD
QUINCY IL
62305-2724
US

V. Phone/Fax

Practice location:
  • Phone: 217-740-7494
  • Fax:
Mailing address:
  • Phone: 217-740-7494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2010018153
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180016296
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: