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General NPI Number Information
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NPI Number | 1366925752
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Entity Type | Individual
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Provider Name | CHRISTOPHER MISSIMO MA, NCC, LPC-I
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Gender | Male
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Dates
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Enumeration Date | 09/11/2018
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Last Update Date | 01/16/2020
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Provider Practice Location Address
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Address Line | 7135 COLLEYVILLE BLVD STE 101
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City | COLLEYVILLE
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State | TX
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Zip | 76034-6455
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Country | US
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Telephone | 817-416-7169
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Fax | 817-416-7175
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Provider Business Mailing Address
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Address Line | 7135 COLLEYVILLE BLVD STE 101
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City | COLLEYVILLE
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State | TX
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Zip | 76034-6455
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Country | US
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Telephone |
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Fax |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 76782
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License Number State | TX
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