Provider Demographics
NPI:1215947627
Name:TISHER, CHRISTINA ANN (LCPC, LPC)
Entity type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANN
Last Name:TISHER
Suffix:
Gender:F
Credentials:LCPC, LPC
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:TISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16006 SURFVIEW CT
Mailing Address - Street 2:
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1907
Mailing Address - Country:US
Mailing Address - Phone:636-458-2275
Mailing Address - Fax:636-821-1279
Practice Address - Street 1:2642 HIGHWAY 109 STE F
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:MO
Practice Address - Zip Code:63040-1132
Practice Address - Country:US
Practice Address - Phone:314-874-7972
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-005846101YP2500X
MO2000173235101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL600001329OtherMAGELLAN