Healthcare Provider Details

I. General information

NPI: 1710983234
Provider Name (Legal Business Name): THEODORE G HIRSCHINGER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 COUNTY ROAD 306
FULTON MO
65251-5436
US

IV. Provider business mailing address

321 W PROMENADE ST
MEXICO MO
65265-2719
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-3215
  • Fax: 573-642-3071
Mailing address:
  • Phone: 573-582-1234
  • Fax: 573-582-1212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000971
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: