Provider Demographics
NPI:1215089172
Name:STROUP, CHARLEEN KAY (LMHC, LPN, CAP, BCPC)
Entity type:Individual
Prefix:MRS
First Name:CHARLEEN
Middle Name:KAY
Last Name:STROUP
Suffix:
Gender:F
Credentials:LMHC, LPN, CAP, BCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 MEDICAL CENTER AVE
Mailing Address - Street 2:P.O. BOX 8952
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5423
Mailing Address - Country:US
Mailing Address - Phone:863-381-4410
Mailing Address - Fax:863-382-6299
Practice Address - Street 1:107 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5423
Practice Address - Country:US
Practice Address - Phone:863-381-4410
Practice Address - Fax:863-382-6299
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCAP 2646101YA0400X
FLMH7283101YM0800X
FLPN1247231164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No164X00000XNursing Service ProvidersLicensed Vocational Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11530315OtherCAQH
FL8049OtherAPA-BCPC