Individual
MRS. MARY ELLEN THEODORE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
321 N MUNN AVE, MARYVILLE, MO 64468-2146
(660) 582-3086
(660) 582-3086
Mailing address
321 N MUNN AVE, MARYVILLE, MO 64468-2146
(660) 582-3086
(660) 582-3086
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
002394
MO
101YP2500X
Professional Counselor
002394
MO
Other
Enumeration date
05/27/2008
Last updated
05/27/2008
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