Active NPI
Robert P. Wissore, LPC
- Professional Counselor
- Sikeston, MO
National Provider Identifier
1154462455
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 000577
- Practice address
- 102 S Interstate Dr
Sikeston, MO 63801 - Phone
- (573) 472-3400
- Fax
- (573) 472-2937
- NPI assigned
- Feb 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 000577 | MO | Primary |
Addresses
Primary practice location
102 S Interstate Dr
Sikeston, MO 63801
Mailing address
Route 1 Box 28
Marquand, MO 63655
Phone (573) 866-2767
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000577 | MO | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170979200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1154462455",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ROUTE 1 BOX 28",
"city": "MARQUAND",
"state": "MO",
"postal_code": "63655",
"telephone_number": "573-866-2767",
"fax_number": "573-472-2937"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "102 S INTERSTATE DR",
"city": "SIKESTON",
"state": "MO",
"postal_code": "63801",
"telephone_number": "573-472-3400",
"fax_number": "573-472-2937"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WISSORE",
"first_name": "ROBERT",
"middle_name": "P.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "000577",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sikeston, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.