Provider Demographics
NPI:1134852759
Name:STAVROPOULOS, KONSTANTINOS A
Entity type:Individual
Prefix:
First Name:KONSTANTINOS
Middle Name:A
Last Name:STAVROPOULOS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 E SIBLEY ST
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-3474
Mailing Address - Country:US
Mailing Address - Phone:773-392-5530
Mailing Address - Fax:
Practice Address - Street 1:244 E SIBLEY ST
Practice Address - Street 2:
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-3474
Practice Address - Country:US
Practice Address - Phone:773-392-5530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180014526101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional