Provider Demographics
NPI:1902036593
Name:RASCOE, MARY JEAN (MS)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:JEAN
Last Name:RASCOE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:RASCOE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:503 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:KY
Mailing Address - Zip Code:42071-2541
Mailing Address - Country:US
Mailing Address - Phone:270-753-2757
Mailing Address - Fax:270-753-2757
Practice Address - Street 1:503 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MURRAY
Practice Address - State:KY
Practice Address - Zip Code:42071-2541
Practice Address - Country:US
Practice Address - Phone:270-753-2757
Practice Address - Fax:270-753-2757
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-17
Last Update Date:2010-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0073103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical