Provider Demographics
NPI:1114010832
Name:PRICE, MARY K (PHD,MS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:K
Last Name:PRICE
Suffix:
Gender:F
Credentials:PHD,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2065-1 DELTA WAY
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303
Mailing Address - Country:US
Mailing Address - Phone:850-656-1822
Mailing Address - Fax:850-656-2905
Practice Address - Street 1:2065-1 DELTA WAY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303
Practice Address - Country:US
Practice Address - Phone:850-656-1822
Practice Address - Fax:850-656-2905
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3028103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75203Medicare ID - Type Unspecified