Provider Demographics
NPI:1679978852
Name:MEWETT, MARY GRACE (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:GRACE
Last Name:MEWETT
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15851 DALLAS PKWY
Mailing Address - Street 2:SUITE 600
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3369
Mailing Address - Country:US
Mailing Address - Phone:214-546-2569
Mailing Address - Fax:
Practice Address - Street 1:15851 DALLAS PKWY
Practice Address - Street 2:SUITE 600
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3369
Practice Address - Country:US
Practice Address - Phone:214-546-2569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-29
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70398101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional