Provider Demographics
NPI:1306462361
Name:CHUPIK, JEFFREY JARED (LPC)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JARED
Last Name:CHUPIK
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-1108
Mailing Address - Country:US
Mailing Address - Phone:254-624-6761
Mailing Address - Fax:254-773-0919
Practice Address - Street 1:3010 SCOTT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-6803
Practice Address - Country:US
Practice Address - Phone:254-624-6761
Practice Address - Fax:254-773-4022
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX74285OtherLPC