Healthcare Provider Details

I. General information

NPI: 1649449760
Provider Name (Legal Business Name): MARY JANE MCLAGGAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JANE PEREZ LMHC

II. Dates (important events)

Enumeration Date: 02/22/2008
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 IOWA AVE W STE 102
MARSHALLTOWN IA
50158-2985
US

IV. Provider business mailing address

1200 UNIVERSITY AVE STE 200
DES MOINES IA
50314-2355
US

V. Phone/Fax

Practice location:
  • Phone: 641-753-4021
  • Fax: 515-644-6792
Mailing address:
  • Phone: 515-248-1447
  • Fax: 515-248-1440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number121856
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19406
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701004224
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: