Provider Demographics
NPI:1730183062
Name:TREADWELL, MARY JAN (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:JAN
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:1701 WHITE STREET
Mailing Address - City:MCCOMB
Mailing Address - State:MS
Mailing Address - Zip Code:39648
Mailing Address - Country:US
Mailing Address - Phone:601-249-4228
Mailing Address - Fax:601-249-4244
Practice Address - Street 1:1701 WHITE STREET
Practice Address - Street 2:
Practice Address - City:MCCOMB
Practice Address - State:MS
Practice Address - Zip Code:39648
Practice Address - Country:US
Practice Address - Phone:601-249-4228
Practice Address - Fax:601-249-4244
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX094161041C0700X
TX1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical