MRS. MARY ELLEN THEODORE (NPI# 1699933630) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699933630 |
| Entity Type | Individual |
| Full Name | MRS. MARY ELLEN THEODORE |
| Credential | LPC |
| Practice Address |
321 N Munn Ave Maryville MO 64468-2146 |
| Practice Telephone | 6605823086 |
| Practice Fax Number | 6605823086 |
| Mailing Telephone | 6605823086 |
| Mailing Fax Number | 6605823086 |
| Enumeration Date | 2008-05-27 |
| Last Update Date | 2008-05-27 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 101YM0800X |
Counselor Specialization: Mental Health |
002394 | MO | Behavioral Health & Social Service Providers |
| N | 101YP2500X |
Counselor Specialization: Professional |
002394 | MO | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063675700 | Mary Eugenia Theodore | Psychiatry & Neurology | 31 W 12th St, Suite 1e, New York, NY 10011-8500 | 2008-07-02 |
| Street Address |
321 N MUNN AVE |
| City | MARYVILLE |
| State | MO |
| Zip Code | 64468-2146 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619315603 | William Sean Prescott | Counselor | 318 North Main, Maryville, MO 64468 | 2013-06-12 |
| 1215284617 | Janet Luzmoor | Counselor | 109 East Summit Dr, Maryville, MO 64468 | 2012-08-06 |
| 1629336177 | Kristi Renee White | Social Worker | 423 N Market St, Maryville, MO 64468 | 2012-05-02 |
| 1285942474 | Kyle William Bowers | Physical Therapist | 2016 South Main Street, Maryville, MO 64468 | 2010-09-22 |
| 1861600660 | Debra Anne Hopkins | Physical Therapist | 2416 South Main St, Maryville, MO 64468 | 2007-05-18 |
| 1023235975 | Susan Kay Grispino | Occupational Therapist | Area Cooperative for Educational Support, 1429 South Munn Avenue, Maryville, MO 64468 | 2007-04-20 |
| 1760542567 | North West Missouri State University | Clinic/Center | 800 University Drive, Maryville, MO 64468 | 2006-12-11 |
| 1528154994 | Bruce E Twaddle | Dentist | 231 Summit Drive, Maryville, MO 64468 | 2006-10-05 |
| 1669588075 | Stanley David Snyder | Dentist | 2825 South Main Street, Maryville, MO 64468 | 2006-08-21 |
| 1710906896 | Ileen Richey-arellin | Social Worker | 109 E Summit Drive, Family Guidance Center, Maryville, MO 64468 | 2006-07-19 |
| Find all providers in zip 64468 | ||||
| Taxonomy Code | 101YM0800X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Counselor |
| Specialization | Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063937290 | Rachel Ryan Mcmillan | Counselor | 362 High Street, Maryville, TN 37804 | 2017-08-09 |
| 1033653167 | Kathleen Ann Puckett | Counselor | 1017 Hampshire Dr, Maryville, TN 37801-3525 | 2016-12-08 |
| 1528426152 | Jesse Williams | Counselor | 200 E Broadway Ave Ste 314b, Maryville, TN 37804-5709 | 2016-02-10 |
| 1326441528 | Kelsey Perkins | Counselor | 6201 W Main St Ste 120, Maryville, IL 62062-6870 | 2014-10-01 |
| 1255753927 | North Star Counseling and Wellness Center | Counselor | 811 Micah St, Maryville, TN 37804-3084 | 2014-01-14 |
| 1851627327 | Jaynie Bradley Moore | Counselor | 315 Home Ave, Maryville, TN 37801-3970 | 2009-10-19 |
| 1285832725 | Katherine E Bentley-knowles | Counselor | 347 High St, Maryville, TN 37804-5831 | 2007-07-06 |
| 1194879833 | Alicia Drew | Counselor | 2016 Vadalabene Dr Ste A, Maryville, IL 62062-6901 | 2007-01-22 |
| 1053492637 | Melissa D. Frye | Counselor | 1012 E Lamar Alexander Pkwy, Maryville, TN 37804-5132 | 2006-10-18 |
| 1518073683 | Christina M Kittstein | Counselor | 6209 E Main St, Maryville, IL 62062-2015 | 2006-08-22 |
| Find all providers in MARYVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.