Provider Demographics
NPI:1568630432
Name:DENNIE, MARY BETH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:DENNIE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 EUREKA ST
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-5439
Mailing Address - Country:US
Mailing Address - Phone:817-629-9132
Mailing Address - Fax:817-594-9995
Practice Address - Street 1:418 EUREKA ST
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-5439
Practice Address - Country:US
Practice Address - Phone:817-629-9132
Practice Address - Fax:817-594-9995
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-13
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62443101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192250202Medicaid
TX192250201Medicaid