Provider Demographics
NPI:1083967475
Name:CHUPIK, CYNTHIA ANN (LCDC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:CHUPIK
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 58
Mailing Address - Street 2:
Mailing Address - City:BEASLEY
Mailing Address - State:TX
Mailing Address - Zip Code:77417-0058
Mailing Address - Country:US
Mailing Address - Phone:713-206-3325
Mailing Address - Fax:
Practice Address - Street 1:1114 N FULTON ST
Practice Address - Street 2:
Practice Address - City:WHARTON
Practice Address - State:TX
Practice Address - Zip Code:77488-3128
Practice Address - Country:US
Practice Address - Phone:979-282-8100
Practice Address - Fax:979-282-8103
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9884101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX9884OtherLCDC