Provider Demographics
NPI:1144593179
Name:SPEED, MARY COLEEN (LMFT/PHD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:COLEEN
Last Name:SPEED
Suffix:
Gender:F
Credentials:LMFT/PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-1907
Mailing Address - Country:US
Mailing Address - Phone:318-680-5960
Mailing Address - Fax:318-274-3114
Practice Address - Street 1:211 W ALABAMA AVE
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-4301
Practice Address - Country:US
Practice Address - Phone:318-680-5960
Practice Address - Fax:318-274-3114
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-22
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA725106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist