Healthcare Provider Details

I. General information

NPI: 1134276504
Provider Name (Legal Business Name): MARY E ISAACS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

281 S JEFFERSON AVE SUITE J
LEBANON MO
65536-3226
US

IV. Provider business mailing address

281 S JEFFERSON AVE SUITE J
LEBANON MO
65536-3226
US

V. Phone/Fax

Practice location:
  • Phone: 417-588-2933
  • Fax: 417-588-2375
Mailing address:
  • Phone: 417-588-2933
  • Fax: 417-588-2375

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number2006005737
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2006005737
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2006005737
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: