Provider Demographics
NPI:1972585487
Name:LEMON, MARY VIRGINIA COBB (LSCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:VIRGINIA COBB
Last Name:LEMON
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:VIRGINIA
Other - Last Name:BONILLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1102 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2318
Mailing Address - Country:US
Mailing Address - Phone:620-245-5000
Mailing Address - Fax:620-245-5099
Practice Address - Street 1:1102 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2318
Practice Address - Country:US
Practice Address - Phone:620-245-5000
Practice Address - Fax:620-245-5099
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS20991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
069361Medicare ID - Type Unspecified
P19264Medicare UPIN