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General NPI Number Information
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NPI Number | 1144593179
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Entity Type | Individual
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Provider Name | MARY COLEEN SPEED LMFT/PHD
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Gender | Female
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Dates
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Enumeration Date | 02/22/2012
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Last Update Date | 02/22/2012
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Provider Practice Location Address
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Address Line | 211 W ALABAMA AVE
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City | RUSTON
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State | LA
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Zip | 71270-4301
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Country | US
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Telephone | 318-680-5960
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Fax | 318-274-3114
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Provider Business Mailing Address
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Address Line | 1000 WEDGEWOOD DR
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City | RUSTON
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State | LA
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Zip | 71270-1907
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Country | US
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Telephone | 318-680-5960
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Fax | 318-274-3114
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 725
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License Number State | LA
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