Healthcare Provider Details

I. General information

NPI: 1073997367
Provider Name (Legal Business Name): TIFFANY LENGER LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 12/21/2022
Certification Date: 12/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13160 COUNTY RD 3610
ST. JAMES MO
65559
US

IV. Provider business mailing address

13160 COUNTY ROAD 3610
SAINT JAMES MO
65559-9151
US

V. Phone/Fax

Practice location:
  • Phone: 573-899-7124
  • Fax:
Mailing address:
  • Phone: 573-899-7124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2015040226
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: