Provider Demographics
NPI:1649374265
Name:SPECK, MARY SUE
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SUE
Last Name:SPECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 COUNTY ROAD 515
Mailing Address - Street 2:
Mailing Address - City:MYRTLE
Mailing Address - State:MS
Mailing Address - Zip Code:38650-9117
Mailing Address - Country:US
Mailing Address - Phone:662-538-7660
Mailing Address - Fax:662-224-0079
Practice Address - Street 1:152 HIGHWAY 7 S
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-5392
Practice Address - Country:US
Practice Address - Phone:662-234-7521
Practice Address - Fax:662-236-3071
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health