Provider Demographics
NPI:1023424678
Name:DERRINGTON, MAYRA A (MA, LPLC)
Entity type:Individual
Prefix:
First Name:MAYRA
Middle Name:A
Last Name:DERRINGTON
Suffix:
Gender:F
Credentials:MA, LPLC
Other - Prefix:
Other - First Name:MAYRA
Other - Middle Name:A
Other - Last Name:MOLINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1300 E BRADFORD PKWY
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4264
Mailing Address - Country:US
Mailing Address - Phone:417-761-5000
Mailing Address - Fax:417-761-5011
Practice Address - Street 1:1322 S CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-1445
Practice Address - Country:US
Practice Address - Phone:417-761-7760
Practice Address - Fax:417-890-7357
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health