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General NPI Number Information
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NPI Number | 1669012753
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Entity Type | Organization
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Legal Business Name | KALOUPEK COUNSELING, LLC
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 106 N MAIN ST
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City | DECATUR
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State | IL
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Zip | 62523-1207
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Country | US
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Telephone | 217-330-6282
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Fax | 217-481-8701
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Provider Business Mailing Address
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Address Line | 106 N MAIN ST
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City | DECATUR
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State | IL
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Zip | 62523-1207
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Country | US
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Telephone | 217-330-6282
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Fax | 217-481-8701
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Authorized Official
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Title or Position | OWNER
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Name | HEATHER MICHELLE KALOUPEK
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Credential | LCSW
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Telephone | 217-330-6282
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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