Provider Demographics
NPI:1053481291
Name:BORST, TIFFANY SCHUSTER (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:SCHUSTER
Last Name:BORST
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4738
Mailing Address - Country:US
Mailing Address - Phone:573-449-1577
Mailing Address - Fax:573-442-0699
Practice Address - Street 1:601 W NIFONG BLVD
Practice Address - Street 2:BLDG. 5A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-6804
Practice Address - Country:US
Practice Address - Phone:573-449-1577
Practice Address - Fax:573-442-0699
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO002371101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional