Provider Demographics
NPI:1063258796
Name:MUNIZ, MARY KATHRYN C (MA, PLPC)
Entity type:Individual
Prefix:
First Name:MARY KATHRYN
Middle Name:C
Last Name:MUNIZ
Suffix:
Gender:F
Credentials:MA, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7124 CAMBRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63130-2302
Mailing Address - Country:US
Mailing Address - Phone:561-568-7455
Mailing Address - Fax:
Practice Address - Street 1:3109 S GRAND BLVD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-1090
Practice Address - Country:US
Practice Address - Phone:561-568-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023017678101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor