Healthcare Provider Details

I. General information

NPI: 1598875080
Provider Name (Legal Business Name): MARY STOCKTON LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/01/2024
Certification Date: 07/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 CENTER STREET
BOWLING GREEN KY
42101
US

IV. Provider business mailing address

380 SUWANNEE TRAIL ST
BOWLING GREEN KY
42103-7956
US

V. Phone/Fax

Practice location:
  • Phone: 270-901-5000
  • Fax: 270-842-6553
Mailing address:
  • Phone: 270-901-5000
  • Fax: 270-842-5268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number104198
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: