Provider Demographics
NPI:1235468786
Name:TUBBERGEN-MAGLIO, TJITSKE GAY (MSW,LCSW)
Entity Type:Individual
Prefix:
First Name:TJITSKE
Middle Name:GAY
Last Name:TUBBERGEN-MAGLIO
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:TISH
Other - Middle Name:GAY
Other - Last Name:TUBBERGEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:117 E WASHINGTON ST
Mailing Address - Street 2:PO BOX 360
Mailing Address - City:KIRKSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63501-2951
Mailing Address - Country:US
Mailing Address - Phone:660-665-7805
Mailing Address - Fax:660-665-7805
Practice Address - Street 1:117 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KIRKSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63501-2951
Practice Address - Country:US
Practice Address - Phone:660-665-7805
Practice Address - Fax:660-665-7805
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-11
Last Update Date:2009-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20090357471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical