MRS. MARY ELLEN THEODORE LPC
NPI 1699933630
Counselor - Mental Health in Maryville, MO
Active since May 27, 2008
About Mrs. Mary Ellen Theodore Lpc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
MRS. MARY ELLEN THEODORE LPC (NPI 1699933630) is an individual mental health provider in Maryville, Missouri, licensed in Missouri (002394) and active in the NPI registry since May 2008.
NPPES Registry Identity
NPI1699933630
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameMRS. MARY ELLEN THEODORECredential: LPC
Location Address321 N MUNN AVEMaryville, MO 64468-2146
Mailing Address321 N Munn AveMaryville, MO 64468-2146 · (660) 582-3086 · Fax (660) 582-3086
Phone(660) 582-3086
Fax(660) 582-3086
Sole ProprietorYes
Enumeration DateMay 27, 2008
✔ NPI 1699933630 is a valid, active identifier and passes the ISO check-digit test.
Specialties & Licenses 2
★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
License✔ Licensed in MO · 002394
Also ListedCounselor · ProfessionalTaxonomy 101YP2500X · License 002394 (MO)
321 N MUNN AVE, Maryville, MO 64468
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1699933630, enumerated as an "individual" on May 27, 2008.
The provider is located at 321 N MUNN AVE MARYVILLE, MO 64468 and the phone number is (660) 582-3086.
Counselor with taxonomy code 101YM0800X and a focus in Mental Health.
