Individual
MARY L. MUCKELROY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
2825 S MERIDIAN RD # 150, MERIDIAN, ID 83642-7960
(208) 297-9495
Mailing address
413 MANGO DR, EAGLE, ID 83616-5123
(972) 822-0440
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
8861451
ID
Other
Enumeration date
03/08/2021
Last updated
09/17/2025
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