Provider Demographics
NPI:1598194748
Name:CHALOUPKA, CANDICE (LMHC)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:
Last Name:CHALOUPKA
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 N RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:IA
Mailing Address - Zip Code:52031-1249
Mailing Address - Country:US
Mailing Address - Phone:563-362-2907
Mailing Address - Fax:
Practice Address - Street 1:105 N RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:IA
Practice Address - Zip Code:52031-1249
Practice Address - Country:US
Practice Address - Phone:563-362-2907
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00837101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health