Provider Demographics
NPI:1710003843
Name:DROULLARD, MARY W (MA, LP, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:W
Last Name:DROULLARD
Suffix:
Gender:F
Credentials:MA, LP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3499 LEXINGTON AVE N STE 100
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55126-7058
Mailing Address - Country:US
Mailing Address - Phone:651-486-4828
Mailing Address - Fax:651-482-9119
Practice Address - Street 1:3499 LEXINGTON AVE N STE 100
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55126-7058
Practice Address - Country:US
Practice Address - Phone:651-486-4828
Practice Address - Fax:651-482-9119
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1513106H00000X
MN5308103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist