Individual
MARY ELIZABETH KETCHUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
100 STARR AVE STE K, STARKVILLE, MS 39759-4032
(662) 425-1051
(662) 200-5960
Mailing address
142 STIDHAM RD, MATHISTON, MS 39752
(662) 425-1051
(662) 327-1970
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
2188
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069799252
—
MS
Enumeration date
07/05/2018
Last updated
09/10/2021
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