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General NPI Number Information
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NPI Number | 1164722393
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Entity Type | Individual
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Provider Name | MARY JO MCHANEY M.A.
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Gender | Female
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Dates
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Enumeration Date | 10/21/2010
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Last Update Date | 10/21/2010
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Provider Practice Location Address
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Address Line | 100 E SYBELIA AVE SUITE 165
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City | MAITLAND
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State | FL
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Zip | 32751-4763
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Country | US
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Telephone | 407-443-3497
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Fax | 407-645-4032
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Provider Business Mailing Address
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Address Line | 100 E SYBELIA AVE SUITE 165
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City | MAITLAND
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State | FL
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Zip | 32751-4763
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Country | US
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Telephone | 407-443-3497
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Fax | 407-645-4032
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH883
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT648
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License Number State | FL
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