Provider Demographics
NPI:1104415041
Name:MCWILLIE, MARY ELIZABETH BETTY (LPC)
Entity type:Individual
Prefix:
First Name:MARY ELIZABETH
Middle Name:BETTY
Last Name:MCWILLIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3661 CHARLESWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4602
Mailing Address - Country:US
Mailing Address - Phone:901-324-2705
Mailing Address - Fax:
Practice Address - Street 1:3661 CHARLESWOOD AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4602
Practice Address - Country:US
Practice Address - Phone:901-324-2705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN527101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN527OtherCOUNSELING
TN527OtherCOUNSELING PERSONAL AND CAREER