Provider Demographics
NPI:1053827915
Name:MOLITOR, WENDY (LPC)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:MOLITOR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:
Other - Last Name:CARMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 HIGHWAY 87
Mailing Address - Street 2:
Mailing Address - City:ELDON
Mailing Address - State:MO
Mailing Address - Zip Code:65026-4040
Mailing Address - Country:US
Mailing Address - Phone:573-280-4933
Mailing Address - Fax:
Practice Address - Street 1:1900 N PROVIDENCE RD STE 327
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65202-3710
Practice Address - Country:US
Practice Address - Phone:573-280-4933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2022-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2106044211101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490050566Medicaid