Provider Demographics
NPI:1225121262
Name:CHALUPA, CLAY DEBRA (LCPC)
Entity Type:Individual
Prefix:MISS
First Name:CLAY
Middle Name:DEBRA
Last Name:CHALUPA
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4085 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-2117
Mailing Address - Country:US
Mailing Address - Phone:773-883-9100
Mailing Address - Fax:773-883-0005
Practice Address - Street 1:4085 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-2117
Practice Address - Country:US
Practice Address - Phone:773-883-9100
Practice Address - Fax:773-883-0005
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional