Provider Demographics
NPI:1245451806
Name:SHOUPE, DIANA L (M ED, LPC)
Entity type:Individual
Prefix:MS
First Name:DIANA
Middle Name:L
Last Name:SHOUPE
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 E HIGHWAY 28
Mailing Address - Street 2:
Mailing Address - City:OWENSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65066-1588
Mailing Address - Country:US
Mailing Address - Phone:573-437-2959
Mailing Address - Fax:573-437-2974
Practice Address - Street 1:1800 COMMUNITY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MO
Practice Address - Zip Code:64735-8804
Practice Address - Country:US
Practice Address - Phone:660-890-8186
Practice Address - Fax:816-318-3109
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001003594101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO497265306Medicaid