Healthcare Provider Details

I. General information

NPI: 1952382210
Provider Name (Legal Business Name): MARY PATRICIA PLAUT LMSW-ACP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2005
Last Update Date: 12/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 N 8TH ST
WOLFFORTH TX
79382-3219
US

IV. Provider business mailing address

504 N 8TH ST
WOLFFORTH TX
79382-3219
US

V. Phone/Fax

Practice location:
  • Phone: 806-441-4416
  • Fax:
Mailing address:
  • Phone: 806-441-4416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number35761
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: