| Doctor Name: | DEAN CONSTANTOPALOS |
| NPI Number: | 1013316199 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 108 W Market St Bloomington, IL - 617013918 |
| Business Phone Number: | 3098275351 |
| Business Fax Number: | 3098296808 |
| Mailing Address: | 108 W Market St, BLOOMINGTON |
| State: | IL |
| Postal Code: | 617013918 |
| Phone Number: | 3098275351 |
| Fax Number: | 3098296808 |
| NPI Enumeration Date: | 08/14/2014 |
| NPI Last Update Date: | 08/14/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |