Healthcare Provider Details

I. General information

NPI: 1972585487
Provider Name (Legal Business Name): MARY VIRGINIA COBB LEMON LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARY VIRGINIA BONILLA

II. Dates (important events)

Enumeration Date: 11/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 HOSPITAL DR
MCPHERSON KS
67460-2318
US

IV. Provider business mailing address

1102 HOSPITAL DR
MCPHERSON KS
67460-2318
US

V. Phone/Fax

Practice location:
  • Phone: 620-245-5000
  • Fax: 620-245-5099
Mailing address:
  • Phone: 620-245-5000
  • Fax: 620-245-5099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2099
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: