Provider Demographics
NPI:1336575984
Name:BRAMMER, MARY KATHRYN (MS, PLPC)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHRYN
Last Name:BRAMMER
Suffix:
Gender:F
Credentials:MS, PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1835 S STEWART AVE
Mailing Address - Street 2:PLAZA 3 SUITE 100A
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-2581
Mailing Address - Country:US
Mailing Address - Phone:417-773-8941
Mailing Address - Fax:
Practice Address - Street 1:2046 S WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-2142
Practice Address - Country:US
Practice Address - Phone:417-773-8941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-15
Last Update Date:2013-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013033673101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional