Provider Demographics
NPI:1538632914
Name:BODE, TINA (PHD, LMFT, PLLC)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BODE
Suffix:
Gender:F
Credentials:PHD, LMFT, PLLC
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:WAGAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 GREGORY ST
Mailing Address - Street 2:
Mailing Address - City:GLOVERSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12078-1425
Mailing Address - Country:US
Mailing Address - Phone:518-774-7345
Mailing Address - Fax:
Practice Address - Street 1:17 GREGORY ST
Practice Address - Street 2:
Practice Address - City:GLOVERSVILLE
Practice Address - State:NY
Practice Address - Zip Code:12078-1425
Practice Address - Country:US
Practice Address - Phone:518-774-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist