Provider Demographics
NPI:1902272248
Name:STAVROPOULOS, KATHY (PLPC)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:STAVROPOULOS
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575B BLUES LAKE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8587
Mailing Address - Country:US
Mailing Address - Phone:573-364-2007
Mailing Address - Fax:573-202-2402
Practice Address - Street 1:575 BLUES LAKE PKWY
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-8587
Practice Address - Country:US
Practice Address - Phone:573-364-2007
Practice Address - Fax:573-202-2402
Is Sole Proprietor?:No
Enumeration Date:2015-08-20
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015026253101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional