Provider Demographics
NPI:1457552598
Name:BRADY KOVACS, MARY ELLEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BRADY KOVACS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 N. STATE ROUTE Y
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:MO
Mailing Address - Zip Code:65256-9421
Mailing Address - Country:US
Mailing Address - Phone:573-864-7622
Mailing Address - Fax:
Practice Address - Street 1:520 NORTH STATE ROUTE Y
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:MO
Practice Address - Zip Code:65256-9421
Practice Address - Country:US
Practice Address - Phone:572-864-7622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS002385101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health