Provider Demographics
NPI:1891842860
Name:PRICE, MARY JO (LPC)
Entity Type:Individual
Prefix:
First Name:MARY JO
Middle Name:
Last Name:PRICE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4801 WELDON SPRING PKWY
Mailing Address - Street 2:STE. 300
Mailing Address - City:WELDON SPRING
Mailing Address - State:MO
Mailing Address - Zip Code:63304-9101
Mailing Address - Country:US
Mailing Address - Phone:636-949-5760
Mailing Address - Fax:636-949-0729
Practice Address - Street 1:4801 WELDON SPRING PKWY
Practice Address - Street 2:STE. 300
Practice Address - City:WELDON SPRING
Practice Address - State:MO
Practice Address - Zip Code:63304-9101
Practice Address - Country:US
Practice Address - Phone:636-949-5760
Practice Address - Fax:636-949-0729
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002032337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO197240OtherBCBS ID FOR LPC
MO499331213Medicaid