Individual
MARY BETH DEBRODIE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW, PHD
Contact information
Practice address
601 W NIFONG, BLDG. 5A, COLUMBIA, MO 65203
(573) 220-8366
(573) 592-8929
Mailing address
PO BOX 456, ASHLAND, MO 65010
(573) 220-8366
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
2003018483
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
498394238
—
MO
Enumeration date
12/16/2005
Last updated
09/20/2023
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