Healthcare Provider Details

I. General information

NPI: 1912858242
Provider Name (Legal Business Name): CLIFTON LITTLEPAGE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2026
Last Update Date: 02/04/2026
Certification Date: 02/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3259 E SUNSHINE ST STE L
SPRINGFIELD MO
65804-2143
US

IV. Provider business mailing address

3259 E SUNSHINE ST STE L
SPRINGFIELD MO
65804-2143
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-5483
  • Fax: 417-889-5483
Mailing address:
  • Phone: 417-889-5483
  • Fax: 417-889-5483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2026005055
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: