Provider Demographics
NPI:1265557722
Name:MARY JANE PRINGLE
Entity type:Organization
Organization Name:MARY JANE PRINGLE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SENIOR MEMBER, CLINICAL SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PRINGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:520-322-9184
Mailing Address - Street 1:2509 N CAMPBELL AVE
Mailing Address - Street 2:430
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85719-3304
Mailing Address - Country:US
Mailing Address - Phone:520-322-9184
Mailing Address - Fax:
Practice Address - Street 1:3840 E LEE ST
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-3721
Practice Address - Country:US
Practice Address - Phone:520-322-9184
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-40751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty