Provider Demographics
NPI:1326035247
Name:LISTON, MARK ALLEN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALLEN
Last Name:LISTON
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2205 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-3021
Mailing Address - Country:US
Mailing Address - Phone:417-782-1290
Mailing Address - Fax:417-782-1290
Practice Address - Street 1:2205 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3021
Practice Address - Country:US
Practice Address - Phone:417-782-1290
Practice Address - Fax:417-782-1290
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000815101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional