Provider Demographics
NPI:1740609940
Name:LISTON, JEFFERY C (LMSW)
Entity Type:Individual
Prefix:MR
First Name:JEFFERY
Middle Name:C
Last Name:LISTON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 N 12TH ST
Mailing Address - Street 2:STE.1
Mailing Address - City:CENTERVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52544-1439
Mailing Address - Country:US
Mailing Address - Phone:641-856-2688
Mailing Address - Fax:641-856-2690
Practice Address - Street 1:501 N 12TH ST
Practice Address - Street 2:STE.1
Practice Address - City:CENTERVILLE
Practice Address - State:IA
Practice Address - Zip Code:52544-1439
Practice Address - Country:US
Practice Address - Phone:641-856-2688
Practice Address - Fax:641-856-2690
Is Sole Proprietor?:No
Enumeration Date:2014-04-15
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA05587104100000X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker