Provider Demographics
NPI:1811558869
Name:NEILL, MARY (LMFT)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:NEILL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 W 15TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7275
Mailing Address - Country:US
Mailing Address - Phone:469-708-9012
Mailing Address - Fax:
Practice Address - Street 1:1255 W 15TH ST STE 320
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7275
Practice Address - Country:US
Practice Address - Phone:469-708-9012
Practice Address - Fax:972-596-5131
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202932106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist