Provider Demographics
NPI:1558382713
Name:TREMBLAY, MARY ANN (LPC, MHSP, CEAP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ANN
Last Name:TREMBLAY
Suffix:
Gender:F
Credentials:LPC, MHSP, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 SANDERS BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:THREE WAY
Mailing Address - State:TN
Mailing Address - Zip Code:38343-8545
Mailing Address - Country:US
Mailing Address - Phone:731-784-1710
Mailing Address - Fax:
Practice Address - Street 1:25 SECURITY DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-3626
Practice Address - Country:US
Practice Address - Phone:731-668-1123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC 1480101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health