Healthcare Provider Details

I. General information

NPI: 1811504889
Provider Name (Legal Business Name): MARY KATE FRANCIS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY KATE BLEVINS LPC

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 11/24/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12166 OLD BIG BEND RD
KIRKWOOD MO
63122-6844
US

IV. Provider business mailing address

2 BUCKINGHAM PL APT A
SAINT CHARLES MO
63301-1198
US

V. Phone/Fax

Practice location:
  • Phone: 314-822-8888
  • Fax:
Mailing address:
  • Phone: 404-317-4567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2020039192
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0701009679
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: