Doctor Name: | MARY CHRISTINA REDDEN |
NPI Number: | 1114167012 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MA, QMHP |
License Number: | |
Business Practice Address: | 16342 N Il Hwy 37 Mt. Vernon, IL - 62864 |
Business Phone Number: | 6182421510 |
Business Fax Number: | 6182420958 |
Mailing Address: | Po Box 428, MOUNT VERNON |
State: | IL |
Postal Code: | 628640054 |
Phone Number: | 6182421510 |
Fax Number: | 6182420958 |
NPI Enumeration Date: | 03/05/2009 |
NPI Last Update Date: | 03/05/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |