Individual
COURTNEY L HUPP
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2148 VADALABENE DR, MARYVILLE, IL 62062-5632
(618) 205-8111
Mailing address
560 BERKSHIRE DR, TROY, IL 62294-1288
(618) 670-7287
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
25430
IL
1041C0700X
Clinical Social Worker
Primary
149.010943
—
1041C0700X
Clinical Social Worker
149010943
IL
Other
Enumeration date
10/22/2013
Last updated
12/03/2019
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