Provider Demographics
NPI:1184732794
Name:MERNAUGH, MARY ANN (LPC)
Entity type:Individual
Prefix:MS
First Name:MARY ANN
Middle Name:
Last Name:MERNAUGH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:MARY ANN
Other - Middle Name:
Other - Last Name:DIMATTIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 2578
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72503-2578
Mailing Address - Country:US
Mailing Address - Phone:870-994-2106
Mailing Address - Fax:870-994-7868
Practice Address - Street 1:714-A ASHFLAT DRIVE
Practice Address - Street 2:
Practice Address - City:ASHFLAT AR
Practice Address - State:AR
Practice Address - Zip Code:72513
Practice Address - Country:US
Practice Address - Phone:870-994-2106
Practice Address - Fax:870-994-7868
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP0507049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5Y528Medicaid