MRS. TINA YVONNE PETTIFORD LPC NPI 1366711939

NPI Information

NPI: 1366711939
Provider Name: MRS. TINA YVONNE PETTIFORD, LPC
Classification: Counselor - 101YP2500X
Entity Type: Individual

Specialization: Professional

Address:
5501 N PARK DR
EAST SAINT LOUIS, IL
ZIP 62204
Phone: (618) 244-5119
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MRS. Tina Yvonne Pettiford, LPC is a professional counselor in East Saint Louis, IL. MRS. Tina Yvonne Pettiford, LPC NPI is 1366711939. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

5501 N PARK DR
EAST SAINT LOUIS, IL
ZIP 62204-121
Phone: (618) 244-5119

The enumeration date for this NPI number is 12/27/2011 and was last updated on 12/27/2011.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	101Y00000X	Counselor		178.006219	ILLINOIS	No
2	101YM0800X	Counselor	Mental Health	178.006219	ILLINOIS	No
3	101YS0200X	Counselor	School	2341716	ILLINOIS	No
4	106H00000X	Marriage & Family Therapist		178.006219	ILLINOIS	No
5	101YP2500X	Counselor	Professional	178.006219	ILLINOIS	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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