Provider Demographics
NPI:1730464520
Name:PURI, MARY BETH (PLPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:PURI
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9011 WRENWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63144-1601
Mailing Address - Country:US
Mailing Address - Phone:208-250-2724
Mailing Address - Fax:
Practice Address - Street 1:1260 SAINT PAUL RD
Practice Address - Street 2:
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63021-8207
Practice Address - Country:US
Practice Address - Phone:636-386-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011033845101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional