| Doctor Name: | MARY FOUGNER |
| NPI Number: | 1477871911 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 6401011243 |
| Business Practice Address: | 9875 Palmoor St White Lake, MI - 483862841 |
| Business Phone Number: | 2487603255 |
| Business Fax Number: | |
| Mailing Address: | 9875 Palmoor St, WHITE LAKE |
| State: | MI |
| Postal Code: | 483862841 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 05/07/2010 |
| NPI Last Update Date: | 01/27/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YP2500X |
| License Number: | 6401011243 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Professional |
| Taxonomy Definition: | |