Provider Demographics
NPI:1720105398
Name:JEPPSEN, MARY LOUISE (MHPP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISE
Last Name:JEPPSEN
Suffix:
Gender:F
Credentials:MHPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 ADMIRAL SEMMES AVE
Mailing Address - Street 2:
Mailing Address - City:DAUPHIN ISLAND
Mailing Address - State:AL
Mailing Address - Zip Code:36528-4551
Mailing Address - Country:US
Mailing Address - Phone:479-981-1065
Mailing Address - Fax:
Practice Address - Street 1:4321 BOULEVARD PARK S
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-3404
Practice Address - Country:US
Practice Address - Phone:479-981-1062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP1002017101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health