Healthcare Provider Details

I. General information

NPI: 1588589030
Provider Name (Legal Business Name): TICKNOR COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N JEFFERSON AVE
SPRINGFIELD MO
65806-1110
US

IV. Provider business mailing address

405 N JEFFERSON AVE
SPRINGFIELD MO
65806-1110
US

V. Phone/Fax

Practice location:
  • Phone: 402-687-6449
  • Fax: 402-687-6449
Mailing address:
  • Phone: 402-687-6449
  • Fax: 402-687-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: BRENDA LEE TICKNOR
Title or Position: OWNER
Credential: MS, LIMHP, LPC, LADC
Phone: 402-687-6449