Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101Y00000X | Counselor | 2012040744 | MO |
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2012040744 | MO |
Y | 101YM0800X | Mental Health Counselor | 2012040744 | MO |
N | 101YP2500X | Professional Counselor | 2012040744 | MO |
NPI | 1003153446 |
---|---|
Provider Name | Mrs. Lori Renee Radford |
First Address | Highlandville, MO 65669-8172 |
Second Address | Springfield, MO 65806-2604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2013 |
Last Update Date | 04/01/2013 |