Healthcare Provider Details

I. General information

NPI: 1376683532
Provider Name (Legal Business Name): PHILLIP MICHAEL TONGIER LMLP, LPC, J.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2990 MILITARY AVE
BAXTER SPRINGS KS
66713-2331
US

IV. Provider business mailing address

3011 N MICHIGAN ST
PITTSBURG KS
66762-2546
US

V. Phone/Fax

Practice location:
  • Phone: 620-856-2900
  • Fax: 620-856-2901
Mailing address:
  • Phone: 620-231-9873
  • Fax: 620-231-5062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number290
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number413
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: