Provider Demographics
NPI:1215053483
Name:ALLEN, MARY A (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:A
Last Name:ALLEN
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 1:413 HISTORIC ROUTE 66
Mailing Address - Street 2:
Mailing Address - City:W. WAYNESVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65583
Mailing Address - Country:US
Mailing Address - Phone:573-774-4198
Mailing Address - Fax:573-774-4951
Practice Address - Street 1:413 HISTORIC ROUTE 66
Practice Address - Street 2:
Practice Address - City:W. WAYNESVILLE
Practice Address - State:MO
Practice Address - Zip Code:65583
Practice Address - Country:US
Practice Address - Phone:573-774-4198
Practice Address - Fax:573-774-4951
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2011-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001033074101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional