Provider Demographics
NPI:1972195238
Name:UTSMAN, MARY JOHNSON (LMFT-A)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:JOHNSON
Last Name:UTSMAN
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:BETHANY
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT-A
Mailing Address - Street 1:809 N LAFAYETTE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-3978
Mailing Address - Country:US
Mailing Address - Phone:704-284-0554
Mailing Address - Fax:
Practice Address - Street 1:809 N LAFAYETTE ST STE 200
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3978
Practice Address - Country:US
Practice Address - Phone:704-284-0554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12281A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist