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General NPI Number Information
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NPI Number | 1801071956
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Entity Type | Individual
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Provider Name | MARY DUREEN HENNESSEY M.A., LPC
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Gender | Female
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 01/08/2008
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Provider Practice Location Address
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Address Line | 303 SAN JUAN AVE
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City | ALAMOSA
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State | CO
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Zip | 81101-2551
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Country | US
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Telephone | 719-589-5800
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Fax | 719-589-1539
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Provider Business Mailing Address
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Address Line | 303 SAN JUAN AVE
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City | ALAMOSA
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State | CO
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Zip | 81101-2551
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Country | US
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Telephone | 719-589-5800
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Fax | 719-589-1539
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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 | 687
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License Number State | CO
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