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General NPI Number Information
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NPI Number | 1215947627
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Entity Type | Individual
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Provider Name | CHRISTINA ANN TISHER L.C.P.C., L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2642 HIGHWAY 109 STE F
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City | WILDWOOD
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State | MO
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Zip | 63040-1132
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Country | US
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Telephone | 314-874-7972
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Fax |
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Provider Business Mailing Address
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Address Line | 16006 SURFVIEW CT
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City | GROVER
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State | MO
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Zip | 63040-1907
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Country | US
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Telephone | 636-458-2275
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Fax | 636-821-1279
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180-005846
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 2000173235
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License Number State | MO
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