Provider Demographics
NPI:1134276504
Name:ISAACS, MARY E (MS)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:ISAACS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:281 S JEFFERSON AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:LEBANON
Mailing Address - State:MO
Mailing Address - Zip Code:65536-3226
Mailing Address - Country:US
Mailing Address - Phone:417-588-2933
Mailing Address - Fax:417-588-2375
Practice Address - Street 1:281 S JEFFERSON AVE
Practice Address - Street 2:SUITE J
Practice Address - City:LEBANON
Practice Address - State:MO
Practice Address - Zip Code:65536-3226
Practice Address - Country:US
Practice Address - Phone:417-588-2933
Practice Address - Fax:417-588-2375
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006005737101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2006005737OtherP.L.P.C.