Individual
TALLIE L STAFFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
104 CRESCENT DR, LEBANON, MO 65536-3301
(417) 588-5885
Mailing address
104 CRESCENT DR, LEBANON, MO 65536-3301
(417) 588-5885
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2022044555
MO
Other
Enumeration date
11/09/2022
Last updated
11/09/2022
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