Provider Demographics
NPI:1689203036
Name:CAHILLY, MARY C (LPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:C
Last Name:CAHILLY
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 1:2165 N CAMINO AGRIOS
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-5908
Mailing Address - Country:US
Mailing Address - Phone:484-330-0413
Mailing Address - Fax:
Practice Address - Street 1:2165 N CAMINO AGRIOS
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85715-5908
Practice Address - Country:US
Practice Address - Phone:484-330-0413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006091101YP2500X
AZLPC-18630101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional