Healthcare Provider Details

I. General information

NPI: 1144309071
Provider Name (Legal Business Name): TRISA REA REDINGTON M.S. LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

283 AUDRAIN COUNTY RD. 233
CENTRALIA MO
65240-5217
US

IV. Provider business mailing address

283 AUDRAIN COUNTY RD. 233
CENTRALIA MO
65240-5217
US

V. Phone/Fax

Practice location:
  • Phone: 660-651-2320
  • Fax: 573-682-2530
Mailing address:
  • Phone: 660-651-2320
  • Fax: 573-682-2530

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2004008733
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: