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NPI Code Detail

MEDICARE: MARY LEE WOLFE LMSW, CSW

MEDICARE: MARY LEE WOLFE LMSW, CSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor6801046584MI

General Provider Information

NPI Number : 1770538266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LEE WOLFE LMSW, CSW
Provider Business Mailing Address
First Line : 1714 EASTMAN AVE
Second Line :
City : MIDLAND
State : MI
Zip : 48640-4216
Country : US
Telephone Number : 989-631-5390
Fax Number : 989-631-0488
Provider Business Practice Location Address
First Line : 1714 EASTMAN AVE
Second Line :
City : MIDLAND
State : MI
Zip : 48640-4216
Country : US
Telephone Number : 989-631-5390
Fax Number : 989-631-0488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2006
Last Update Date : 07/08/2007

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