MRS. Mary Ellen Theodore, LPC

NPI #1699933630 in Maryville, Missouri

Provider Information

NPI Number: 1699933630
Entity Type: Individual
Name: MRS. Mary Ellen Theodore, LPC
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Counselor - Mental Health
Credential: LPC
Enumeration Date: May 27, 2008
Last Updated: May 27, 2008

Practice Location

Address: 321 N MUNN AVE
City: Maryville
State: Missouri
ZIP Code: 64468-2146
Phone: (660) 582-3086

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Counselor - Mental Health — Mental Health	101YM0800X	Primary
Counselor - Professional — Professional	101YP2500X

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