Provider Demographics
NPI:1265831648
Name:NORTHINGTON, DANA RENEE (RN, BSN, MA, LPC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:RENEE
Last Name:NORTHINGTON
Suffix:
Gender:F
Credentials:RN, BSN, MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3832 SW WINDSONG DR
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64082-4050
Mailing Address - Country:US
Mailing Address - Phone:816-786-7449
Mailing Address - Fax:
Practice Address - Street 1:1942 NW COPPER OAKS CIR
Practice Address - Street 2:
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64015-8300
Practice Address - Country:US
Practice Address - Phone:816-786-7449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-21
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014001283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional