1174010367 NPI number — PROF. ELIZABETH DEMETRA TSAHIRIDIS MSMHC MSED PLPC CIT

Table of content: PROF. ELIZABETH DEMETRA TSAHIRIDIS MSMHC MSED PLPC CIT (NPI 1174010367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174010367 NPI number — PROF. ELIZABETH DEMETRA TSAHIRIDIS MSMHC MSED PLPC CIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TSAHIRIDIS
Provider First Name:
ELIZABETH
Provider Middle Name:
DEMETRA
Provider Name Prefix Text:
PROF.
Provider Name Suffix Text:
Provider Credential Text:
MSMHC MSED PLPC CIT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TSAHIRIDIS
Provider Other First Name:
LIZA
Provider Other Middle Name:
DEMETRA
Provider Other Name Prefix Text:
PROF.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSMHC MSED PLPC CIT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1174010367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 COMFORT LANE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANSON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-598-2656
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 N GRETNA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANSON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65616-7243
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-598-2656
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/13/2018

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 102L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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