Provider Demographics
NPI:1598354417
Name:FITZPATRICK, MARY HOSTON
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:HOSTON
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
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 3223
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36109-0223
Mailing Address - Country:US
Mailing Address - Phone:337-279-7830
Mailing Address - Fax:
Practice Address - Street 1:2140 UPPER WETUMPKA RD
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36107-1342
Practice Address - Country:US
Practice Address - Phone:334-279-7830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health