Provider Demographics
NPI:1003153446
Name:RADFORD, LORI RENEE (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:RENEE
Last Name:RADFORD
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3379 STATE HIGHWAY O
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65669-8172
Mailing Address - Country:US
Mailing Address - Phone:417-434-5105
Mailing Address - Fax:
Practice Address - Street 1:1041 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65806-2604
Practice Address - Country:US
Practice Address - Phone:417-459-2117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-04
Last Update Date:2013-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012040744101Y00000X, 101YA0400X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional