=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235963091
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIFEQUEST COUNSELING SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/26/2024
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 910 S BLUFFVIEW DR
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67218-3024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-807-4418
-----------------------------------------------------
Fax | 888-316-9320
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 21467
-----------------------------------------------------
City | WICHITA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67208-7467
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-807-4188
-----------------------------------------------------
Fax | 316-807-4188
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/LEAD PSYCHOTHERAPIST
-----------------------------------------------------
Name | ALLYSA L HUPKO
-----------------------------------------------------
Credential | LCSCW
-----------------------------------------------------
Telephone | 316-807-4418
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------