Provider Demographics
NPI:1245692854
Name:COLIZZA, MARY E (MAC, PLPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:E
Last Name:COLIZZA
Suffix:
Gender:F
Credentials:MAC, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 DEER TRACKS TRL
Mailing Address - Street 2:SUITE 260
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63131-1839
Mailing Address - Country:US
Mailing Address - Phone:314-282-7270
Mailing Address - Fax:314-394-1404
Practice Address - Street 1:1715 DEER TRACKS TRL
Practice Address - Street 2:SUITE 260
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63131-1839
Practice Address - Country:US
Practice Address - Phone:314-282-7270
Practice Address - Fax:314-394-1404
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013041573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional