Provider Demographics
NPI:1538219464
Name:WINGO, KATHY A (EDD, LPC,LMF)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:A
Last Name:WINGO
Suffix:
Gender:F
Credentials:EDD, LPC,LMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S GLENSTONE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0313
Mailing Address - Country:US
Mailing Address - Phone:417-862-8282
Mailing Address - Fax:417-862-8805
Practice Address - Street 1:1111 S GLENSTONE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0313
Practice Address - Country:US
Practice Address - Phone:417-862-8282
Practice Address - Fax:417-862-8805
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001415101YP2500X
MO2000143809106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO169563OtherBCBS PROVIDER NUMBER