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Individual
MARY ELLEN SPENCER
Active
Individual
MARY ELLEN SPENCER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
L.P.C.
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
19379
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
173556501
—
TX
01
—
261489
COMPSYCH
TX
01
—
7515LC
BLUE CROSS/BLUE SHIELD
TX
Enumeration date
08/14/2006
Last updated
02/11/2010
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