Provider Demographics
NPI:1134484934
Name:MCCONE, MARYELLEN (LPC/MHSP)
Entity Type:Individual
Prefix:
First Name:MARYELLEN
Middle Name:
Last Name:MCCONE
Suffix:
Gender:F
Credentials:LPC/MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7
Mailing Address - Street 2:
Mailing Address - City:SEWANEE
Mailing Address - State:TN
Mailing Address - Zip Code:37375-0007
Mailing Address - Country:US
Mailing Address - Phone:931-636-4415
Mailing Address - Fax:
Practice Address - Street 1:15260 SEWANEE HWY
Practice Address - Street 2:
Practice Address - City:SEWANEE
Practice Address - State:TN
Practice Address - Zip Code:37375-2788
Practice Address - Country:US
Practice Address - Phone:931-636-4415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-08
Last Update Date:2012-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional