Provider Demographics
NPI:1801071956
Name:HENNESSEY, MARY DUREEN (MA, LPC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:DUREEN
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SAN JUAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALAMOSA
Mailing Address - State:CO
Mailing Address - Zip Code:81101-2551
Mailing Address - Country:US
Mailing Address - Phone:719-589-5800
Mailing Address - Fax:719-589-1539
Practice Address - Street 1:303 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:ALAMOSA
Practice Address - State:CO
Practice Address - Zip Code:81101-2551
Practice Address - Country:US
Practice Address - Phone:719-589-5800
Practice Address - Fax:719-589-1539
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO687101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health