Basic Information
| Provider Information | |||||||||
| NPI: | 1376683532 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TONGIER | ||||||||
| FirstName: | PHILLIP | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | LMLP, LPC, J.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3011 N MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667622546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6202319873 | ||||||||
| FaxNumber: | 6202315062 | ||||||||
| Practice Location | |||||||||
| Address1: | 2990 MILITARY AVE | ||||||||
| Address2: | |||||||||
| City: | BAXTER SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 667132331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6208562900 | ||||||||
| FaxNumber: | 6208562901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2007 | ||||||||
| LastUpdateDate: | 05/18/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 290 | KS | Y | Behavioral Health & Social Service Providers | Psychologist | 101YA0400X | 413 | KS | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.