Provider Demographics
NPI:1134143159
Name:TRAGASZ, RICHARD PAUL (LPC)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:PAUL
Last Name:TRAGASZ
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:PO BOX 189
Mailing Address - Street 2:
Mailing Address - City:SAINT JAMES
Mailing Address - State:MO
Mailing Address - Zip Code:65559-0189
Mailing Address - Country:US
Mailing Address - Phone:573-636-4253
Mailing Address - Fax:573-636-4253
Practice Address - Street 1:4304 S BEARFIELD RD
Practice Address - Street 2:BOYS AND GIRLS TOWN OF MISSOURI
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-9557
Practice Address - Country:US
Practice Address - Phone:573-874-8686
Practice Address - Fax:573-874-8608
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2009-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006007087101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional