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NPI Code Detail

MEDICARE: MRS. MARY SUE SPECK

MEDICARE: MRS. MARY SUE SPECK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1649374265
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARY SUE SPECK
Provider Business Mailing Address
First Line : 1329 COUNTY ROAD 515
Second Line :
City : MYRTLE
State : MS
Zip : 38650-9117
Country : US
Telephone Number : 662-538-7660
Fax Number : 662-224-0079
Provider Business Practice Location Address
First Line : 152 HIGHWAY 7 S
Second Line :
City : OXFORD
State : MS
Zip : 38655-5392
Country : US
Telephone Number : 662-234-7521
Fax Number : 662-236-3071
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/12/2006
Last Update Date : 02/11/2016

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Directions to “ MRS. MARY SUE SPECK ” Practice Location

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