Provider Demographics
NPI:1033170907
Name:MEHESS, MARY ALICE (LCSW, LAC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ALICE
Last Name:MEHESS
Suffix:
Gender:F
Credentials:LCSW, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 TAMAR CT
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-3510
Mailing Address - Country:US
Mailing Address - Phone:719-568-2531
Mailing Address - Fax:
Practice Address - Street 1:20 TAMAR CT
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-3510
Practice Address - Country:US
Practice Address - Phone:719-568-2531
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9897631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical