Provider Demographics
NPI:1225651631
Name:VILLAREAL, MARY ELLEN (LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELLEN
Last Name:VILLAREAL
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 1:7018 BLANKENSHIP CIR
Mailing Address - Street 2:
Mailing Address - City:DAVISON
Mailing Address - State:MI
Mailing Address - Zip Code:48423-2317
Mailing Address - Country:US
Mailing Address - Phone:810-241-4098
Mailing Address - Fax:
Practice Address - Street 1:7018 BLANKENSHIP CIR
Practice Address - Street 2:
Practice Address - City:DAVISON
Practice Address - State:MI
Practice Address - Zip Code:48423-2317
Practice Address - Country:US
Practice Address - Phone:810-241-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-20
Last Update Date:2025-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401016715101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health