Provider Demographics
NPI:1770779910
Name:MOUTRAY, CHRISTINA ANN (MA, LPC)
Entity type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:ANN
Last Name:MOUTRAY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E PARK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:CHAMPAIGN
Mailing Address - State:IL
Mailing Address - Zip Code:61820-3862
Mailing Address - Country:US
Mailing Address - Phone:815-683-8185
Mailing Address - Fax:
Practice Address - Street 1:411 E PARK ST STE 106
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61820-3862
Practice Address - Country:US
Practice Address - Phone:815-683-8185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-21
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.021204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional