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General NPI Number Information
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NPI Number | 1457552598
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Entity Type | Individual
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Provider Name | MARY ELLEN BRADY KOVACS L.P.C.
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Gender | Female
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Dates
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Enumeration Date | 05/29/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 520 NORTH STATE ROUTE Y
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City | HARRISBURG
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State | MO
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Zip | 65256-9421
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Country | US
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Telephone | 572-864-7622
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Fax |
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Provider Business Mailing Address
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Address Line | 520 N. STATE ROUTE Y
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City | HARRISBURG
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State | MO
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Zip | 65256-9421
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Country | US
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Telephone | 573-864-7622
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Fax |
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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 | CS002385
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License Number State | MO
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