Provider Demographics
NPI:1114117462
Name:SKIPPER, STATES VICTOR (LPC)
Entity Type:Individual
Prefix:MR
First Name:STATES
Middle Name:VICTOR
Last Name:SKIPPER
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:372 TINDEL LANE
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MO
Mailing Address - Zip Code:65753
Mailing Address - Country:US
Mailing Address - Phone:417-581-4505
Mailing Address - Fax:
Practice Address - Street 1:1835 E REPUBLIC RD
Practice Address - Street 2:ONE SPRINGFIELD PLACE BLDG SUITE 204
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-887-3822
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2007-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000551101YM0800X
ARP0503020101YM0800X
TX18873101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health