Individual provider · Type 1 NPI

Mary Lane Mickens

Professional Counselor · Texarkana, TX

NPI number 1265594345 Active

Practice location

5221 N Park Rd
Texarkana, TX 75503-2664

Call (903) 791-1051 Map

Fax (903) 791-1053

Mailing address

30 Sherry Rdg
Texarkana, TX 75501-2040

Specialties and licenses

TaxonomyCodeLicense
Professional Counselor Primary 101YP2500X19530 (TX)

Professional Counselor: Definition to come...

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About NPI 1265594345

Mary Lane Mickens's National Provider Identifier is 1265594345, issued on Dec 14, 2006. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in Texarkana, TX. The record was last updated on Jul 8, 2007.