Provider Demographics
NPI:1790293439
Name:CALVIN, MARY ROGENIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ROGENIA
Last Name:CALVIN
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 1:11747 HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FRANKFORD
Mailing Address - State:MO
Mailing Address - Zip Code:63441-2148
Mailing Address - Country:US
Mailing Address - Phone:573-754-2406
Mailing Address - Fax:
Practice Address - Street 1:11747 HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FRANKFORD
Practice Address - State:MO
Practice Address - Zip Code:63441-2148
Practice Address - Country:US
Practice Address - Phone:573-754-2406
Practice Address - Fax:573-754-2406
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017044750101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional