Provider Demographics
NPI:1932922713
Name:MARY R CALVIN
Entity type:Organization
Organization Name:MARY R CALVIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ROGENIA
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:573-754-2406
Mailing Address - Street 1:11747 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:MO
Mailing Address - Zip Code:63441-2148
Mailing Address - Country:US
Mailing Address - Phone:573-754-2406
Mailing Address - Fax:
Practice Address - Street 1:11747 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:MO
Practice Address - Zip Code:63441-2148
Practice Address - Country:US
Practice Address - Phone:573-754-2406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-01
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty