Provider Demographics
NPI:1457449753
Name:PICKTON, MARY E (LPCC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:PICKTON
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:E
Other - Last Name:GAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:96 GRAHAM ROAD
Mailing Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223
Mailing Address - Country:US
Mailing Address - Phone:330-929-1326
Mailing Address - Fax:330-929-1327
Practice Address - Street 1:96 GRAHAM ROAD
Practice Address - Street 2:SUITE A RESERVE PSYCHOLOGICAL CONSULTANTS INC
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44223
Practice Address - Country:US
Practice Address - Phone:330-929-1326
Practice Address - Fax:330-929-1327
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE2836101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional