Healthcare Provider Details

I. General information

NPI: 1053481291
Provider Name (Legal Business Name): TIFFANY SCHUSTER BORST MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W NIFONG BLVD BLDG. 5A
COLUMBIA MO
65203-6804
US

IV. Provider business mailing address

1705 S FAIRVIEW RD
COLUMBIA MO
65203-4738
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-1577
  • Fax: 573-442-0699
Mailing address:
  • Phone: 573-449-1577
  • Fax: 573-442-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number002371
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: