Tallie L Stafford, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

2022044555 Issued in MO

Practice address

104 Crescent Dr
Lebanon, MO 65536-3301

Phone

(417) 588-5885

NPI assigned

Nov 9, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lenz LPC LLC

  • Professional Counselor
  • Saint Louis, MO
  • NPI 1700467776

  Social Worker

  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1667952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1417665308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 CRESCENT DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363301",
            "telephone_number": "417-588-5885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 CRESCENT DR",
            "city": "LEBANON",
            "state": "MO",
            "postal_code": "655363301",
            "telephone_number": "417-588-5885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STAFFORD",
        "first_name": "TALLIE",
        "middle_name": "L",
        "credential": "LMSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-09",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "MO",
            "license": "2022044555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Norman Sommers, OD
• Spirit 522 Inc
• St John'S Hospital Lebanon
• St Johns Clinic Inc
• St. John'S Regional Health Center
• Starla Walton Counseling LLC
• Courtney Michele Starnes, SLPA
• Lindsey Stephens
• Starlynn M Stinson, NP-C
• Amy Stockton

• Social Worker in Lebanon, MO
• Providers in Lebanon, MO by specialty
• Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.