Individual
MRS. CHRISTINA ANN TISHER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.C.P.C., L.P.C.
Contact information
Practice address
2642 HIGHWAY 109 STE F, WILDWOOD, MO 63040-1132
(314) 874-7972
Mailing address
16006 SURFVIEW CT, GROVER, MO 63040-1907
(636) 458-2275
(636) 821-1279
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
180-005846
IL
101YP2500X
Professional Counselor
Primary
2000173235
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
600001329
MAGELLAN
IL
Enumeration date
08/08/2006
Last updated
07/23/2021
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