Provider Demographics
NPI:1639236862
Name:MCKENYON, MARY ANNE (LPC)
Entity Type:Individual
Prefix:
First Name:MARY ANNE
Middle Name:
Last Name:MCKENYON
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 1:413 W. BETHEL RD.
Mailing Address - Street 2:100
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4474
Mailing Address - Country:US
Mailing Address - Phone:972-393-1596
Mailing Address - Fax:972-304-0400
Practice Address - Street 1:413 W. BETHEL RD.
Practice Address - Street 2:100
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4474
Practice Address - Country:US
Practice Address - Phone:972-393-1596
Practice Address - Fax:972-304-0400
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional