Provider Demographics
NPI:1962526350
Name:PADDOCK, JANA L (LPC)
Entity type:Individual
Prefix:
First Name:JANA
Middle Name:L
Last Name:PADDOCK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 UNION AVE STE 2500
Mailing Address - Street 2:
Mailing Address - City:MOBERLY
Mailing Address - State:MO
Mailing Address - Zip Code:65270-9412
Mailing Address - Country:US
Mailing Address - Phone:660-372-1313
Mailing Address - Fax:660-372-1339
Practice Address - Street 1:1513 UNION AVE STE 2500
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9412
Practice Address - Country:US
Practice Address - Phone:660-372-1313
Practice Address - Fax:660-372-1339
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002011661101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO495017402Medicaid