Provider Demographics
NPI:1780773879
Name:KOON, MARY ELIZABETH (RN MED LADC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELIZABETH
Last Name:KOON
Suffix:
Gender:F
Credentials:RN MED LADC
Other - Prefix:
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Mailing Address - Street 1:62 WOODBURY RD
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:NH
Mailing Address - Zip Code:03070
Mailing Address - Country:US
Mailing Address - Phone:603-487-2732
Mailing Address - Fax:
Practice Address - Street 1:2013 ELM ST
Practice Address - Street 2:PASTORAL COUNSELING SERVICES
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104
Practice Address - Country:US
Practice Address - Phone:603-627-2702
Practice Address - Fax:603-627-3643
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH035101YA0400X
NH01976321163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health