Provider Demographics
NPI:1356429245
Name:MATTINGLY, MARY ANN (MS LPC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ANN
Last Name:MATTINGLY
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 230684
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99523-0684
Mailing Address - Country:US
Mailing Address - Phone:907-522-2010
Mailing Address - Fax:
Practice Address - Street 1:2600 DENALI ST
Practice Address - Street 2:SUITE 606
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2739
Practice Address - Country:US
Practice Address - Phone:907-522-2010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK338101YP2500X
ARP8703006101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional