Healthcare Provider Details

I. General information

NPI: 1679978852
Provider Name (Legal Business Name): MARY GRACE MEWETT M.S., LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 05/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15851 DALLAS PKWY SUITE 600
ADDISON TX
75001-3369
US

IV. Provider business mailing address

15851 DALLAS PKWY SUITE 600
ADDISON TX
75001-3369
US

V. Phone/Fax

Practice location:
  • Phone: 214-546-2569
  • Fax:
Mailing address:
  • Phone: 214-546-2569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70398
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: