Provider Demographics
NPI:1801142443
Name:MISEGADIS, TINA B (T-LMLP)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:B
Last Name:MISEGADIS
Suffix:
Gender:F
Credentials:T-LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-4139
Mailing Address - Country:US
Mailing Address - Phone:785-628-2871
Mailing Address - Fax:
Practice Address - Street 1:208 E 7TH ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-4139
Practice Address - Country:US
Practice Address - Phone:785-628-2871
Practice Address - Fax:785-628-0330
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KST-LMLP 2677103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical