Provider Demographics
NPI:1063646990
Name:TINER, JOHN WATSON (PLPC)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:WATSON
Last Name:TINER
Suffix:
Gender:M
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 W CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:MO
Mailing Address - Zip Code:65605-1518
Mailing Address - Country:US
Mailing Address - Phone:417-678-5532
Mailing Address - Fax:417-678-6242
Practice Address - Street 1:308 W CHURCH ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:MO
Practice Address - Zip Code:65605-1518
Practice Address - Country:US
Practice Address - Phone:417-678-5532
Practice Address - Fax:417-678-6242
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-06
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009009841101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional