Provider Demographics
NPI:1093225914
Name:COALSON, MARY E (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:COALSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:POIRIER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1366 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5738
Mailing Address - Country:US
Mailing Address - Phone:602-241-5577
Mailing Address - Fax:
Practice Address - Street 1:1366 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85014-5738
Practice Address - Country:US
Practice Address - Phone:602-241-5577
Practice Address - Fax:602-241-5577
Is Sole Proprietor?:No
Enumeration Date:2017-10-05
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16912101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health